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Rattay K, Robinson LR. Identifying Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD): a Public Health Concern and Opportunity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:195-202. [PMID: 38598041 DOI: 10.1007/s11121-024-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders with significant individual and societal negative impacts of the disorder continuing into adulthood (Danielson et al. in Journal of Clinical Child and Adolescent Psychology, in press; Landes and London in Journal of Attention Disorders 25:3-13, 2021). Genetic and environmental risk (e.g., modifiable exposures such as prenatal tobacco exposure and child maltreatment) for ADHD is likely multifactorial (Faraone et al. in Neuroscience & Biobehavioral Reviews 128:789-818, 2021). However, the evidence for potentially modifiable contextual risks is spread across studies with different methodologies and ADHD criteria limiting understanding of the relationship between early risk factors and later childhood ADHD. Using common methodology across six meta-analyses (Bitsko et al. in Prevention Science, 2022; Claussen et al. in Prevention Science 1-23, 2022; Dimitrov et al. in Prevention Science, 2023; Maher et al. in Prevention Science, 2023; Robinson, Bitsko et al. in Prevention Science, 2022; So et al. in Prevention Science, 2022) examining 59 risk factors for childhood ADHD, the papers in this special issue use a public health approach to address prior gaps in the literature. This introductory paper provides examples of comprehensive public health approaches focusing on policy, systems, and environmental changes across socio-ecological contexts to improve health and wellbeing through prevention, early intervention, and support across development using findings from these meta-analyses. Together, the findings from these studies and a commentary by an author independent from the risk studies have the potential to minimize risk conditions, prioritize prevention efforts, and improve the long-term health and wellbeing of children and adults with ADHD.
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Affiliation(s)
- Karyl Rattay
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Lara R Robinson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA
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Blum K, Braverman ER, Gold MS, Dennen CA, Baron D, Thanos PK, Hanna C, Elman I, Gondre-Lewis MC, Ashford JW, Newberg A, Madigan MA, Jafari N, Zeine F, Sunder K, Giordano J, Barh D, Gupta A, Carney P, Bowirrat A, Badgaiyan RD. Addressing cortex dysregulation in youth through brain health check coaching and prophylactic brain development. INNOSC THERANOSTICS & PHARMACOLOGICAL SCIENCES 2024; 7:1472. [PMID: 38766548 PMCID: PMC11100020 DOI: 10.36922/itps.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The Carter Center has estimated that the addiction crisis in the United States (US), if continues to worsen at the same rate, may cost the country approximately 16 trillion dollars by 2030. In recent years, the well-being of youth has been compromised by not only the coronavirus disease 2019 pandemic but also the alarming global opioid crisis, particularly in the US. Each year, deadly opioid drugs claim hundreds of thousands of lives, contributing to an ever-rising death toll. In addition, maternal usage of opioids and other drugs during pregnancy could compromise the neurodevelopment of children. A high rate of DNA polymorphic antecedents compounds the occurrence of epigenetic insults involving methylation of specific essential genes related to normal brain function. These genetic antecedent insults affect healthy DNA and mRNA transcription, leading to a loss of proteins required for normal brain development and function in youth. Myelination in the frontal cortex, a process known to extend until the late 20s, delays the development of proficient executive function and decision-making abilities. Understanding this delay in brain development, along with the presence of potential high-risk antecedent polymorphic variants or alleles and generational epigenetics, provides a clear rationale for embracing the Brain Research Commission's suggestion to mimic fitness programs with an adaptable brain health check (BHC). Implementing the BHC within the educational systems in the US and other countries could serve as an effective initiative for proactive therapies aimed at reducing juvenile mental health problems and eventually criminal activities, addiction, and other behaviors associated with reward deficiency syndrome.
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Affiliation(s)
- Kenneth Blum
- Division of Addiction Research and Education, Center for Sports, Exercise and Global Mental Health, Western University of Health Sciences, Pomona, California, United States of America
- The Kenneth Blum Behavioral and Neurogenetic Institute LLC, Austin, Texas, United States of America
- Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University Budapest, Budapest, Hungary
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
- Division of Personalized Medicine, Cross-Cultural Research and Educational Institute, San Clemente, California, United States of America
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology, Purba Medinipur, West Bengal, India
- Division of Personalized Recovery Science, Transplicegen Therapeutics, Llc., Austin, Tx., United of States
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, United States of America
- Division of Personalized Medicine, Ketamine Clinic of South Florida, Pompano Beach, Florida, United States of America
| | - Eric R. Braverman
- The Kenneth Blum Behavioral and Neurogenetic Institute LLC, Austin, Texas, United States of America
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Catherine A. Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, Pennsylvania, United States of America
| | - David Baron
- Division of Addiction Research and Education, Center for Sports, Exercise and Global Mental Health, Western University of Health Sciences, Pomona, California, United States of America
| | - Panayotis K. Thanos
- Department of Psychology and Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, University of Buffalo, Buffalo, New York, United States of America
| | - Colin Hanna
- Department of Psychology and Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, University of Buffalo, Buffalo, New York, United States of America
| | - Igor Elman
- Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Marjorie C. Gondre-Lewis
- Department of Anatomy, Howard University School of Medicine, Washington, D.C., United States of America
| | - J. Wesson Ashford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, United States of America
| | - Andrew Newberg
- Department of Integrative Medicine and Nutritional Sciences, Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania, United States of America
| | - Margaret A. Madigan
- The Kenneth Blum Behavioral and Neurogenetic Institute LLC, Austin, Texas, United States of America
| | - Nicole Jafari
- Division of Personalized Medicine, Cross-Cultural Research and Educational Institute, San Clemente, California, United States of America
- Department of Human Development, California State University at Long Beach, Long Beach, California, United States of America
| | - Foojan Zeine
- Department of Human Development, California State University at Long Beach, Long Beach, California, United States of America
- Awareness Integration Institute, San Clemente, California, United States of America
| | - Keerthy Sunder
- Department of Health Science, California State University at Long Beach, Long Beach, California, United States of America
- Department of Psychiatry, University California, UC Riverside School of Medicine, Riverside, California, United States of America
| | - John Giordano
- Division of Personalized Medicine, Ketamine Clinic of South Florida, Pompano Beach, Florida, United States of America
| | - Debmayla Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology, Purba Medinipur, West Bengal, India
| | - Ashim Gupta
- Future Biologics, Lawrenceville, Georgia, United States of America
| | - Paul Carney
- Division of Pediatric Neurology, University of Missouri Health Care-Columbia, Columbia, Missouri, United States of America
| | - Abdalla Bowirrat
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Rajendra D. Badgaiyan
- Department of Psychiatry, Mt. Sinai School of Medicine, New York City, New York, United States of America
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de Bejczy A, Addolorato G, Aubin HJ, Guiraud J, Korpi ER, John Nutt D, Witkiewitz K, Söderpalm B. AUD in perspective. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:1-19. [PMID: 38555113 DOI: 10.1016/bs.irn.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.
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Affiliation(s)
- Andrea de Bejczy
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Giovanni Addolorato
- Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy; Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France
| | - Julien Guiraud
- Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Vergio, Clichy, France
| | - Esa R Korpi
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - David John Nutt
- Imperial College London and GABA Labs, London, United Kingdom
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ghetti CM, Hjelmbrekke S, Morken K, Dahl T, Stige B. Steering the energy with music: hermeneutic phenomenological study of user perspectives of music and music therapy for co-occurring ADHD and substance use problems. Subst Abuse Treat Prev Policy 2024; 19:10. [PMID: 38263064 PMCID: PMC10807156 DOI: 10.1186/s13011-024-00594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND User perspectives and involvement are crucial for improving substance use treatment service provision. First-hand accounts provide rich perspectives on how users experience change within therapeutic approaches like music therapy. People with substance use problems have a higher incidence of experiencing challenges with impulsivity, hyperactivity and inattention. Such challenges can negatively affect social functioning and outcomes of substance use treatment. Music therapy can offer people a means to regulate emotions and facilitate social relationships. There is a lack of research on user perspectives of music therapy in substance use treatment, and we could identify no studies that explore user perspectives of music therapy for adults with substance use problems and co-occurring impulsivity, hyperactivity and inattention. METHODS The aim of this phenomenological study was to center the voices of people living with co-occurring attention deficit hyperactivity disorder (ADHD) and substance use disorder (SUD) to understand how they experience music and music therapy in their process of recovery. We used a hermeneutic phenomenological approach to qualitative analysis of transcripts from in-depth interviews with 8 adult service users from a Norwegian substance use treatment facility. RESULTS Our main finding was that music and music therapy enabled experiences of motivation and mastery that ultimately afforded social belonging. The participants demonstrated detailed and nuanced understanding of how they use music to steer the energy and restlessness that are characteristic of ADHD, to change mood, and to shift negative thought patterns. These forms of music-centered regulation served as pre-requisites for more active and gratifying participation in social communities. For several participants, musicking offered a means of establishing drug-free identity and fellowship. The motivation and mastery experienced during musicking lowered the threshold for social engagement, and served as an incentive for continuing substance use treatment for some participants. CONCLUSIONS The nuanced descriptions from our participants illustrate the importance of motivation, and how music therapy can contribute to motivation in substance use treatment. In particular, the context surrounding musicking, adaptations from the music therapist, and social affordances of such musicking contributed to pleasure, mastery, participation, development of identity and social belonging, which in interaction generated motivation.
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Affiliation(s)
- Claire M Ghetti
- GAMUT-The Grieg Academy Music Therapy Research Centre, The Grieg Academy-Department of Music, University of Bergen, 5020, Bergen, Postbox 7805, Norway.
| | - Steinar Hjelmbrekke
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Katharina Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Therese Dahl
- Albatrossen Aftercare Center (The Albatrossen Foundation), Bergen, Norway
| | - Brynjulf Stige
- GAMUT-The Grieg Academy Music Therapy Research Centre, The Grieg Academy-Department of Music, University of Bergen, 5020, Bergen, Postbox 7805, Norway
- Polyfon Knowledge Cluster for Music Therapy, Bergen, Norway
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Kverno K, Ramos-Marcuse F. Reducing Risk in the Treatment of Attention-Deficit/Hyperactivity Disorder Among Adults With Comorbidities. J Psychosoc Nurs Ment Health Serv 2024; 62:8-11. [PMID: 38176004 DOI: 10.3928/02793695-20231212-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Recent widely publicized shortages in the U.S. supply of first-line medications for treatment of attention-deficit/hyperactivity disorder (ADHD) are thought to reflect increases in public awareness, help seeking, and treatment. ADHD is one of the most common neurodevelopmental disorders and is typically identified in childhood. In adulthood, ADHD symptoms are less likely to include hyperactivity, but inattention, impulsivity, and emotional dysregulation are common. Clinical evaluation of symptomatic adults who were not diagnosed as children requires corroboration of ADHD diagnostic symptoms in childhood and careful differentiation of ADHD from frequently co-occurring psychiatric and substance use disorders. Treatment of adult ADHD can result in improved functioning across multiple dimensions and comorbid disorders. Existing guidelines and consensus statements recommend an integrated approach to treating ADHD and all existing comorbid disorders, prioritizing the disorder that is creating the most difficulty for the individual. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 8-11.].
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Bahji A, Danilewitz M, Crockford D. Navigating Evidence, Challenges, and Caution in the Treatment of Stimulant Use Disorders. Brain Sci 2023; 13:1416. [PMID: 37891785 PMCID: PMC10605120 DOI: 10.3390/brainsci13101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/29/2023] Open
Abstract
Amidst the opioid epidemic, harm reduction-oriented approaches have gained traction, including interventions that focus on prescribing pharmaceutical-grade psychoactive substances, such as opioids, instead of illicit versions, intending to mitigate fatal overdose risks arising from the variability in potency and additives found in illicit drugs. Stimulants have increasingly been found in the victims of opioid overdoses, further prompting some to argue for the prescription of stimulant medications for individuals with stimulant use disorders. Yet, the evidence supporting this practice remains insufficient. In this communication, we critically examine the existing evidence, challenges, and cautions surrounding the treatment of stimulant use disorder.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB T2R 0N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2R 0N2, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2R 0N2, Canada
| | - Marlon Danilewitz
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R7, Canada;
- Ontario Shores Center for Mental Health Sciences, Whitby, ON L1N 5S9, Canada
| | - David Crockford
- Department of Psychiatry, University of Calgary, Calgary, AB T2R 0N2, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2R 0N2, Canada
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Guerin AA, Bridson T, Plapp HM, Bedi G. A systematic review and meta-analysis of health, functional, and cognitive outcomes in young people who use methamphetamine. Neurosci Biobehav Rev 2023; 153:105380. [PMID: 37678571 DOI: 10.1016/j.neubiorev.2023.105380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
Methamphetamine use typically starts in adolescence, and early onset is associated with worse outcomes. Yet, health, functional, and cognitive outcomes associated with methamphetamine use in young people are not well understood. The aim of this study was to comprehensively assess the evidence on health, functional, and cognitive outcomes in young people (10-25 years-old) who use methamphetamine. Sixty-six studies were included. The strongest association observed was with conduct disorder, with young people who use methamphetamine some 13 times more likely to meet conduct disorder criteria than controls. They were also more likely to have justice system involvement and to perpetrate violence against others. Educational problems were consistently associated with youth methamphetamine use. The cognitive domain most reliably implicated was inhibitory control. Key limitations in the literature were identified, including heterogenous measurement of exposure and outcomes, lack of adequate controls, and limited longitudinal evidence. Outcomes identified in the present review - suggesting complex and clinically significant behavioural issues in this population - are informative for the development of future research and targeted treatments.
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Affiliation(s)
- Alexandre A Guerin
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, Melbourne, Australia.
| | - Tahnee Bridson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, Melbourne, Australia
| | - Helena M Plapp
- Orygen, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Gillinder Bedi
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, Melbourne, Australia
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Molina BSG, Kennedy TM, Howard AL, Swanson JM, Arnold LE, Mitchell JT, Stehli A, Kennedy EH, Epstein JN, Hechtman LT, Hinshaw SP, Vitiello B. Association Between Stimulant Treatment and Substance Use Through Adolescence Into Early Adulthood. JAMA Psychiatry 2023; 80:933-941. [PMID: 37405756 PMCID: PMC10323757 DOI: 10.1001/jamapsychiatry.2023.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 07/06/2023]
Abstract
Importance Possible associations between stimulant treatment of attention-deficit/hyperactivity disorder (ADHD) and subsequent substance use remain debated and clinically relevant. Objective To assess the association of stimulant treatment of ADHD with subsequent substance use using the Multimodal Treatment Study of ADHD (MTA), which provides a unique opportunity to test this association while addressing methodologic complexities (principally, multiple dynamic confounding variables). Design, Setting, and Participants MTA was a multisite study initiated at 6 sites in the US and 1 in Canada as a 14-month randomized clinical trial of medication and behavior therapy for ADHD but transitioned to a longitudinal observational study. Participants were recruited between 1994 and 1996. Multi-informant assessments included comprehensively assessed demographic, clinical (including substance use), and treatment (including stimulant treatment) variables. Children aged 7 to 9 years with rigorously diagnosed DSM-IV combined-type ADHD were repeatedly assessed until a mean age of 25 years. Analysis took place between April 2018 and February 2023. Exposure Stimulant treatment of ADHD was measured prospectively from baseline for 16 years (10 assessments) initially using parent report followed by young adult report. Main Outcomes and Measures Frequency of heavy drinking, marijuana use, daily cigarette smoking, and other substance use were confidentially self-reported with a standardized substance use questionnaire. Results A total of 579 children (mean [SD] age at baseline, 8.5 [0.8] years; 465 [80%] male) were analyzed. Generalized multilevel linear models showed no evidence that current (B [SE] range, -0.62 [0.55] to 0.34 [0.47]) or prior stimulant treatment (B [SE] range, -0.06 [0.26] to 0.70 [0.37]) or their interaction (B [SE] range, -0.49 [0.70] to 0.86 [0.68]) were associated with substance use after adjusting for developmental trends in substance use and age. Marginal structural models adjusting for dynamic confounding by demographic, clinical, and familial factors revealed no evidence that more years of stimulant treatment (B [SE] range, -0.003 [0.01] to 0.04 [0.02]) or continuous, uninterrupted stimulant treatment (B [SE] range, -0.25 [0.33] to -0.03 [0.10]) were associated with adulthood substance use. Findings were the same for substance use disorder as outcome. Conclusions and Relevance This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD. These findings do not appear to result from other factors that might drive treatment over time and findings held even after considering opposing age-related trends in stimulant treatment and substance use.
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Affiliation(s)
- Brooke S. G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea L. Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - James M. Swanson
- Department of Pediatrics, University of California, Irvine, Irvine
| | - L. Eugene Arnold
- Department of Psychiatry & Behavioral Health, Ohio State University, Columbus
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Annamarie Stehli
- Department of Pediatrics, University of California, Irvine, Irvine
| | - Edward H. Kennedy
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Tschudi L, Fischer SKM, Perlov E, Baumgartner MR, Soyka M, Müller TJ, Seifritz E, Mutschler J. Concomitant Drug Use among Opioid-Dependent Patients with and without Attention Deficit Hyperactivity Disorder: Does Methylphenidate Merit a Trial? Eur Addict Res 2023; 29:305-312. [PMID: 37517394 DOI: 10.1159/000531008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Concomitant drug use is common among opioid-dependent patients in maintenance therapy. Attention deficit hyperactivity disorder (ADHD), a common comorbidity among opioid users, is associated with a higher risk of concomitant drug use. Earlier studies showed that methylphenidate (MPH) can reduce cocaine consumption among patients with ADHD. The use of MPH as an agonist-replacement or maintenance therapy in cocaine-dependent patients without ADHD is also common in Switzerland, despite a lack of supporting evidence. The aim of this study was to assess concomitant cocaine, amphetamine, MDMA, MPH, and heroin use among patients in opioid maintenance therapy either with or without comorbid ADHD. We expected stimulant consumption to be higher in patients with cocaine dependence and comorbid ADHD and that use of MPH would not lead to a reduction in cocaine consumption in patients without ADHD. We therefore evaluated correlations between use of MPH and cocaine consumption and between MPH consumption and cocaine craving within the two groups. METHODS This cross-sectional study included 94 opioid-dependent patients in maintenance therapy in an outpatient department of the Psychiatric Hospital of Zurich. The patients were divided into two groups based on comorbid ADHD; a group with ADHD (N = 27) and a group without ADHD (N = 67). Drug use was assessed using 3-month hair analysis. RESULTS We did not find significant differences in the number of patients using cocaine, amphetamine, MDMA, or heroin between groups with or without ADHD. With respect to cocaine use, 85.2 percent of patients in the ADHD group and 73.1 percent in the non-ADHD group were users. The non-ADHD group showed a significant positive correlation between the concentration of MPH and cocaine in hair samples (p < 0.05), and a positive correlation between cocaine craving and the concentration of MPH in hair samples (p = 0.065). These two trends were not evident in the ADHD group. CONCLUSION Among patients without ADHD, use of MPH correlates with higher cocaine consumption and craving. Conversely, no significant correlation was found between MPH and cocaine use in patients with ADHD. Our study adds to the evidence that MPH confers negative effects in cocaine users without ADHD and should thus have no place in the treatment of these patients.
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Affiliation(s)
- Letizia Tschudi
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Sebastian Karl Maximilian Fischer
- Psychiatric Services Lucerne, Lucerne, Switzerland
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Munich, Germany
| | | | - Markus R Baumgartner
- Zurich Institute of Forensic Medicine, Center for Forensic Hair Analysis, University of Zurich, Zurich, Switzerland
| | - Michael Soyka
- Department of Psychiatry and Psychotherapy, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Barbuti M, Maiello M, Spera V, Pallucchini A, Brancati GE, Maremmani AGI, Perugi G, Maremmani I. Challenges of Treating ADHD with Comorbid Substance Use Disorder: Considerations for the Clinician. J Clin Med 2023; 12:jcm12093096. [PMID: 37176536 PMCID: PMC10179386 DOI: 10.3390/jcm12093096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Adults with attention deficit/hyperactivity disorder (ADHD) often present psychiatric comorbidities and, in particular, substance use disorder (SUD). ADHD-SUD comorbidity is characterized by greater severity of both disorders, earlier age of onset, higher likelihood of polydrug-abuse and suicidal behaviors, more hospitalizations, and lower treatment adherence. At the present stage, research focused on the pharmacological management of ADHD with comorbid SUD in both adolescents and adults is still lacking. Furthermore, while the short-term effects of stimulants are well studied, less is known about the chronic effects of these drugs on dopamine signaling. Current available evidence is consistent in reporting that high doses of stimulant medications in ADHD-SUD subjects have a mild to moderate efficacy on ADHD symptoms. Some data suggest that pharmacological treatment with stimulants may be beneficial for both ADHD symptoms and comorbid cocaine or amphetamine use. However, in the long run, stimulant medications may have a potential risk for misuse. For the absence of potential misuse, atomoxetine is often recommended for ADHD with comorbid cocaine or amphetamine use disorder. However, its efficacy in reducing addictive behavior is not demonstrated. In subjects with other subtypes of SUD, both atomoxetine and stimulant drugs seem to have scarce impact on addictive behavior, despite the improvement in ADHD symptomatology. In this population, ADHD treatment should be combined with SUD-specific strategies.
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Affiliation(s)
- Margherita Barbuti
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Marco Maiello
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Vincenza Spera
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Alessandro Pallucchini
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Giulio E Brancati
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Angelo G I Maremmani
- Section of Psychiatry, Department of Psychiatry and Addictions, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Lido di Camaiore, Italy
| | - Giulio Perugi
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Icro Maremmani
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
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11
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Schieber LZ, Dunphy C, Schieber RA, Lopes-Cardozo B, Moonesinghe R, Guy GP. Hospitalization Associated With Comorbid Psychiatric and Substance Use Disorders Among Adults With COVID-19 Treated in US Emergency Departments From April 2020 to August 2021. JAMA Psychiatry 2023; 80:331-341. [PMID: 36790774 PMCID: PMC9932946 DOI: 10.1001/jamapsychiatry.2022.5047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023]
Abstract
Importance During the COVID-19 pandemic, US emergency department (ED) visits for psychiatric disorders (PDs) and drug overdoses increased. Psychiatric disorders and substance use disorders (SUDs) independently increased the risk of COVID-19 hospitalization, yet their effect together is unknown. Objective To assess how comorbid PD and SUD are associated with the probability of hospitalization among ED patients with COVID-19. Design, Setting, and Participants This retrospective cross-sectional study analyzed discharge data for adults (age ≥18 years) with a COVID-19 diagnosis treated in 970 EDs and inpatient hospitals in the United States from April 2020 to August 2021. Exposures Any past diagnosis of (1) SUD from opioids, stimulants, alcohol, cannabis, cocaine, sedatives, or other substances and/or (2) PD, including attention-deficit/hyperactivity disorder (ADHD), anxiety, bipolar disorder, major depression, other mood disorder, posttraumatic stress disorder (PTSD), or schizophrenia. Main Outcomes and Measures The main outcome was any hospitalization. Differences in probability of hospitalization were calculated to assess its association with both PD and SUD compared with PD alone, SUD alone, or neither condition. Results Of 1 274 219 ED patients with COVID-19 (mean [SD] age, 54.6 [19.1] years; 667 638 women [52.4%]), 18.6% had a PD (mean age, 59.0 years; 37.7% men), 4.6% had a SUD (mean age, 50.1 years; 61.7% men), and 2.3% had both (mean age, 50.4 years; 53.1% men). The most common PDs were anxiety (12.9%), major depression (9.8%), poly (≥2) PDs (6.4%), and schizophrenia (1.4%). The most common SUDs involved alcohol (2.1%), cannabis (1.3%), opioids (1.0%), and poly (≥2) SUDs (0.9%). Prevalence of SUD among patients with PTSD, schizophrenia, other mood disorder, or ADHD each exceeded 21%. Based on significant specific PD-SUD pairs (Q < .05), probability of hospitalization of those with both PD and SUD was higher than those with (1) neither condition by a weighted mean of 20 percentage points (range, 6 to 36; IQR, 16 to 25); (2) PD alone by 12 percentage points (range, -4 to 31; IQR, 8 to 16); and (3) SUD alone by 4 percentage points (range, -7 to 15; IQR, -2 to 7). Associations varied by types of PD and SUD. Substance use disorder was a stronger predictor of hospitalization than PD. Conclusions and Relevance This study found that patients with both PD and SUD had a greater probability of hospitalization, compared with those with either disorder alone or neither disorder. Substance use disorders appear to have a greater association than PDs with the probability of hospitalization. Overlooking possible coexisting PD and SUD in ED patients with COVID-19 can underestimate the likelihood of hospitalization. Screening and assessment of both conditions are needed.
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Affiliation(s)
- Lyna Z. Schieber
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher Dunphy
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard A. Schieber
- Office of Director, Center for Surveillance, Epidemiology, and Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara Lopes-Cardozo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Young S, Abbasian C, Al-Attar Z, Branney P, Colley B, Cortese S, Cubbin S, Deeley Q, Gudjonsson GH, Hill P, Hollingdale J, Jenden S, Johnson J, Judge D, Lewis A, Mason P, Mukherjee R, Nutt D, Roberts J, Robinson F, Woodhouse E, Cocallis K. Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World J Psychiatry 2023; 13:84-112. [PMID: 37033892 PMCID: PMC10075023 DOI: 10.5498/wjp.v13.i3.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.
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Affiliation(s)
- Susan Young
- Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cyrus Abbasian
- Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
| | | | - Polly Branney
- ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
| | - Bill Colley
- CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Sally Cubbin
- Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
| | - Quinton Deeley
- Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
| | - Gisli Hannes Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Peter Hill
- Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
| | - Jack Hollingdale
- Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
| | | | - Joe Johnson
- Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
| | | | - Alexandra Lewis
- Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
| | - Peter Mason
- Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
| | - Raja Mukherjee
- Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
| | - David Nutt
- Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
| | - Jane Roberts
- Service User Representative, Gloucestershire GL1 3NN, United Kingdom
| | - Fiona Robinson
- Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Kelly Cocallis
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
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Etterlid-Hägg V, Pauli M, Howner K. A Comparative Study of Prison Inmates With and Without ADHD: Which Neuropsychological and Self-Report Measures are Most Effective in Detecting ADHD Within Correctional Services? J Atten Disord 2023; 27:721-730. [PMID: 36927135 DOI: 10.1177/10870547231158764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE In this study we aimed to investigate the screening and diagnostic properties of various self-report instruments to identify measures which most effectively detect ADHD in a correctional sample. METHOD The sample consisted of 193 male high security prisoners in Sweden. We investigated if measures of ADHD symptoms, executive functioning, impulsivity, estimated IQ and working memory could differentiate participants with ADHD from those with ASPD or no diagnosis. RESULTS Participants with ADHD obtained significantly higher total scores on all included measures. Although we found that some of the measures were more efficient in differentiating ADHD, mean values were generally elevated in the sample. CONCLUSION Results demonstrate the importance of investigating psychometric properties in relevant samples to assure a measurement's usefulness in different contexts, in this case a correctional setting, where the high influence of unspecific behavioral indicators in these measurements might negatively affect their validity.
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Affiliation(s)
| | - Malin Pauli
- National Board of Forensic Medicine, Stockholm, Sweden.,Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Katarina Howner
- National Board of Forensic Medicine, Stockholm, Sweden.,Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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14
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Babajanyan D, Freame L, Steele R, Poulton A. Understanding Attentional Functioning in Adult Attention Deficit Hyperactivity Disorder-Could This Improve Diagnostic Specificity? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5077. [PMID: 36981985 PMCID: PMC10049217 DOI: 10.3390/ijerph20065077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The diagnostic criteria for attention deficit hyperactivity disorder (ADHD) reflect the behavioural and functional outcomes of cognitive processes. Historically they have been based on external observations and lack specificity: clinical cohorts of children meeting diagnostic criteria show that around 40% may also meet diagnostic criteria for oppositional defiant disorder (ODD). We have proposed a clinical model to explain this: the Mental Effort Reward Imbalances model of ADHD (MERIM). This model views the lower levels of task completion that underlie several of the diagnostic criteria for ADHD as being due to a summation of deficits in executive functioning and reward processing. The subjective experience of inadequate reward from task completion may explain the reduced motivation, negativity, and oppositional attitude associated with ODD. The hypothesis for this study is that descriptions of affected individuals' attentional characteristics could be more specific for the executive functioning deficits associated with ADHD than the current symptom-based approaches. To test whether this might be usable in practice, we conducted a workshop that aimed to characterise in depth the patterns of attention experienced by adults with ADHD and how they impact functioning. Three main patterns were described: (1) complete lapses in attention; (2) partial attention to a task; (3) attending to multiple tasks and distractions, either simultaneously or in rapid sequence. All of these resulted in reduced productivity. They also described strategies for managing their attention deficits. Some people used distractions positively, to stimulate the mind to remain active and engaged rather than losing focus. Multi-tasking could also achieve this by providing higher levels of stimulation, however, the stimulation could itself become a distraction. Interest or stress might maintain engagement; extremes could sometimes lead to hyperfocusing, which was typically infrequent but could be highly productive. Focusing on executive functions may improve diagnostic sensitivity, as the current criteria fail to identify people who function adequately due to their use of strategies that mitigate the effects of their attentional deficits. Such people may present with secondary depression or anxiety rather than clear, behavioural symptoms of ADHD. With further development, the approach described in this paper may provide a more simple and fundamental way of recognising ADHD within the community. In the longer term, focusing more specifically on executive functions may provide cohorts with a 'purer' form of ADHD for scientific study.
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Affiliation(s)
- Diana Babajanyan
- Department of Psychology, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Leanne Freame
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Ray Steele
- ADDults with ADHD, 3/51 Wicks Rd., North Ryde, NSW 2113, Australia
| | - Alison Poulton
- Brain Mind Centre Nepean, University of Sydney, 62 Derby St., Kingswood, NSW 2747, Australia
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15
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Hale EW, Coyle TD. Under-Documented or Under-Recognized? Comorbid ADHD in Emergency Department Patients With Addictive Disorders. J Atten Disord 2023; 27:270-272. [PMID: 36354068 DOI: 10.1177/10870547221135800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We sought to examine rates of comorbid ADHD and SUD/AUD using a nationally representative dataset, and to compare this data with established estimates. We hoped to increase available research on ADHD within patients with SUD/AUD. METHODS This study is a retrospective secondary analysis of cross-sectional data collected in the National Hospital Ambulatory Medical Care Survey (NHAMCS). RESULTS The data showed less than 1% of comorbid ADHD in either AUD or SUD, and prevalence of 0.6% in patients with both. Our estimated prevalence of ADHD among SUD/AUD patients is more than 30-fold smaller than the 25% consensus. CONCLUSION The stark difference between our data and prior research indicates a need for further examination of the prevalence of ADHD within acute care. This finding of a large reservoir of ADHD that is unrecognized or undocumented indicates a substantive need for ADHD-focused education with opportunity for improvement in patient treatment.
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16
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Rohner H, Gaspar N, Rosen H, Ebert T, Kilarski LL, Schrader F, Al Istwani M, Lenz AJ, Dilg C, Welskop A, Goldmann T, Schmidt U, Philipsen A. ADHD Prevalence among Outpatients with Severe Opioid Use Disorder on Daily Intravenous Diamorphine and/or Oral Opioid Maintenance Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2534. [PMID: 36767906 PMCID: PMC9915278 DOI: 10.3390/ijerph20032534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Attention deficit hyperactivity disorder (ADHD) is a common comorbid condition in opioid use disorder (OUD) and is associated with a more severe course of substance use. Patients with severe OUD who have not responded to oral opioid maintenance treatment can be treated with intravenous diamorphine up to three times per day. Here, we investigated the prevalence of ADHD among patients undergoing either daily diamorphine maintenance treatment or daily oral opioid maintenance treatment. (2) Methods: We assessed all participants with the WURS-k and the ADHD-SR. The Diagnostic Interview for ADHD in Adults (DIVA) was performed with all participants who met the cut-off in the WURS-k and/or ADHD-SR. (3) Results: The overall prevalence of ADHD was 17.9%. Prevalence of ADHD among patients undergoing daily diamorphine maintenance treatment was 14.3%. Prevalence of ADHD among patients undergoing daily oral opioid maintenance treatment was 20.3%. The combined presentation of ADHD was the most prevalent condition. In urine samples of participants with comorbid ADHD, heroin was detected the most and cocaine the least frequently. (4) Conclusions: Almost one out of five patients with OUD suffered from comorbid ADHD. In 83.3%, ADHD had not been diagnosed prior to participation in this study. Thus, patients with SUD could benefit from being routinely screened for ADHD.
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Affiliation(s)
- Henrik Rohner
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Nikolas Gaspar
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Helena Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Tim Ebert
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Laura Luisa Kilarski
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Felix Schrader
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Moaz Al Istwani
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Anna Julia Lenz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Christoph Dilg
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Andrea Welskop
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Tatjana Goldmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
| | - Ulrike Schmidt
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Center of Goettingen, 37075 Goettingen, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany
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17
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Rocco P. Prevalence of ADHD in a Sample of Heroin Addicts Receiving Agonist Treatment-Study Conducted in a Public Addiction Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2602. [PMID: 36767966 PMCID: PMC9915126 DOI: 10.3390/ijerph20032602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that can persist into adulthood. The co-occurrence of ADHD and substance use disorders is very frequent and has received considerable attention in recent clinical/scientific investigations. However, few studies have investigated the prevalence of ADHD in heroin addicts. This study aimed to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) in a sample of heroin addicts treated with opioid agonists and to report this clinical experience in a public service for addiction. Outpatients over 18 years old and being treated with opioid agonists for heroin addiction were enrolled. Each patient took part in a psychiatric examination and completed an ASRS (Adult ADHD Self-Report Scale) self-assessment. Subjects with positive results were called in for another psychiatric visit, and the Brown ADD scale was used as a second-level test for ADHD; furthermore, the Mini International Neuropsychiatric Interview (MINI) and Hypomania/Mania Checklist (HCL-32) were used for differential diagnoses and to assess comorbidities. In total, 111 patients were enrolled. All were followed up by the psychiatrist, who is also the author of this report and the person who formulated the diagnoses. The prevalence of ADHD in this sample was 18%. Among the 20 patients diagnosed with ADHD, 5 (25%) were female and 15 (75%) were male. The most frequent psychiatric comorbidity was major depression, found in 11 patients (55%), of which 4 presented with hypomania (bipolar disorder). In this sample, making diagnoses was very difficult. Frequently, multiple comorbidities further complicated these cases. In conclusion, the results of this study are consistent with the literature: There seems to be a significant prevalence of ADHD even among heroin addicts, and often, the diagnosis is difficult to make. We also do not know the exact effect of opioid agonist therapy on ADHD symptoms. Hypotheses have been put forward, but studies are needed.
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Affiliation(s)
- Pasqualina Rocco
- Addiction Treatment Center, Local Health Service N. 2, Veneto, Via dei Carpani, 16/Z, 31033 Treviso, Italy
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18
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Kölle M, Philipsen A, Mackert S. [Attention deficit hyperactivity disorder and substance use in adulthood-Guideline-conform diagnostics and treatment]. DER NERVENARZT 2023; 94:47-57. [PMID: 36633607 DOI: 10.1007/s00115-022-01422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/13/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most frequent developmental disorder in childhood, adolescence and adulthood. Substance use disorders are a frequent comorbidity in ADHD. The many different forms and severities of these comorbidities necessitate individual strategies in the diagnostics and treatment. Principally, ADHD and addictive disorders should be treated together whenever possible. The more acute or severe the dependence disorder is, the less priority can be given to the topic of ADHD and the lower are the chances of carrying out valid diagnostics and simultaneous treatment at the beginning of the treatment of the addictive disorder. The less severe and acute the addictive disorder is, the quicker the diagnostics and, if necessary, treatment of ADHD can be initiated. In this continuing education article, the customary means for diagnostics and pharmacotherapy as well as the special features that must be considered with respect to comorbidities of both disorders are presented.
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Affiliation(s)
- Markus Kölle
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Alexandra Philipsen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Sarah Mackert
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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19
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Luderer M, Seidt J, Gerhardt S, Hoffmann S, Vollstädt-Klein S, Reif A, Sobanski E. Drinking alcohol to cope with hyperactive ADHD? Self-reports vs. continuous performance test in patients with ADHD and/or alcohol use disorder. Front Psychiatry 2023; 14:1112843. [PMID: 36950259 PMCID: PMC10025293 DOI: 10.3389/fpsyt.2023.1112843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Rationale Attention deficit/hyperactivity disorder (ADHD) is common in alcohol use disorder (AUD). Continuous performance tests (CPTs) allow to measure ADHD related deficits in a laboratory setting. Most studies on this topic focused on CPTs measuring inattention or impulsivity, disregarding hyperactivity as one of the core symptoms of ADHD. Methods We examined N = 47 in three groups (ADHD N = 19; AUD N = 16; ADHD + AUD N = 12) with questionnaires on ADHD core symptoms, executive functioning (EF), mind wandering, and quality of life (QoL). N = 46 (ADHD N = 16; AUD N = 16; ADHD + AUD N = 14) were examined with a CPT (QbTest®) that also measures motor activity objectively. Results Inattention and impulsivity were significantly increased in AUD vs. ADHD and in AUD vs. ADHD + AUD. Hyperactivity was significantly higher in ADHD + AUD vs. ADHD and ADHD + AUD vs. AUD, but not in ADHD vs. AUD. EF was lower in both ADHD groups vs. AUD. Mind wandering was increased in both ADHD groups vs. AUD. QoL was significantly lower in ADHD + AUD compared to AUD. In contrast, results of the QbTest were not significantly different between groups. Conclusion Questionnaires are more useful in assessing ADHD core symptoms than the QbTest®. Hyperactivity appears to be a relevant symptom in ADHD + AUD, suggesting a possible pathway from ADHD to AUD. The lower QoL in ADHD + AUD emphasizes the need for routine screening, diagnostic procedures and treatment strategies for this patient group.
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Affiliation(s)
- Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- *Correspondence: Mathias Luderer,
| | - Johanna Seidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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20
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Palma-Álvarez RF, Barta C, Carpentier PJ, Carruthers S, Crunelle CL, Demetrovics Z, Dom G, Faraone SV, Franck J, Johnson B, Kapitány-Fövény M, Kaye S, Konstenius M, Matthys F, Moggi F, Møller M, Schellekens A, Skutle A, van de Glind G, van Emmerik-van Oortmerssen K, Verspreet S, Schoevers RA, Wallhed S, Levin FR, Grau-López L, Casas M, van den Brink W, Ramos-Quiroga JA. Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:11-15. [PMID: 32561156 DOI: 10.1016/j.rpsm.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. METHOD A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. RESULTS According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. CONCLUSION The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. SCIENTIFIC SIGNIFICANCE On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.
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Affiliation(s)
- Raul Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | | | - Susan Carruthers
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Cleo L Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geert Dom
- Antwerp University (UA), Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; Psychiatric Center Mutiversum, Boechout, Belgium
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brian Johnson
- Departments of Psychiatry and of Anesthesia, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Máté Kapitány-Fövény
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary; Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Sharlene Kaye
- National Drug and Alcohol Research Center, University of New South Wales, Sydney, Australia
| | - Maija Konstenius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Merete Møller
- Department for Substance Abuse Treatment, Østfold Hospital Trust, Norway
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | | | - Katelijne van Emmerik-van Oortmerssen
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sara Wallhed
- Stockholm Centre for Dependency Disorders, Sweden
| | - Frances R Levin
- Columbia University, the New York State Psychiatric Institute, New York, NY, USA
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Perugi G, De Rosa U, Barbuti M. What value do norepinephrine/dopamine dual reuptake inhibitors have to the current treatment of adult attention deficit hyperactivity disorder (ADHD) treatment armamentarium? Expert Opin Pharmacother 2022; 23:1975-1978. [PMID: 36384367 DOI: 10.1080/14656566.2022.2148830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ugo De Rosa
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Margherita Barbuti
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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22
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Palis H, Gan W, Xavier C, Desai R, Scow M, Sedgemore KO, Greiner L, Nicholls T, Slaunwhite A. Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration. JAMA Netw Open 2022; 5:e2243653. [PMID: 36416821 PMCID: PMC9685494 DOI: 10.1001/jamanetworkopen.2022.43653] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Studies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk. OBJECTIVE To examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022. EXPOSURES Substance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events. RESULTS The study identified 6816 people (5980 male [87.7%]; 2820 aged <30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses. CONCLUSIONS AND RELEVANCE This cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.
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Affiliation(s)
- Heather Palis
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wenqi Gan
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington
| | - Chloe Xavier
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Roshni Desai
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marnie Scow
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kali-olt Sedgemore
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Coalition of Peers Dismantling the Drug War, Vancouver, British Columbia, Canada
| | | | - Tonia Nicholls
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Amanda Slaunwhite
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Brynte C, Aeschlimann M, Barta C, Begeman AHA, Bäcker A, Crunelle CL, Daigre C, De Fuentes-Merillas L, Demetrovics Z, Dom G, López LG, Icick R, Johnson B, Joostens P, Kapitány-Fövény M, Karsinti E, Kiefer F, Konstenius M, Levin FR, Luderer M, Markus W, Matthys F, Moggi F, Palma-Alvarez RF, Paraskevopoulou M, Ramos-Quiroga JA, Schellekens A, Soravia LM, Therribout N, Thomas A, van de Glind G, van Kernebeek MW, Vollstädt-Klein S, Vorspan F, van den Brink W, Franck J. The clinical course of comorbid substance use disorder and attention deficit/hyperactivity disorder: protocol and clinical characteristics of the INCAS study. BMC Psychiatry 2022; 22:625. [PMID: 36151539 PMCID: PMC9502646 DOI: 10.1186/s12888-022-04259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Substance use disorders (SUD) often co-occur with attention deficit hyperactivity disorder (ADHD). Although the short-term effects of some specific interventions have been investigated in randomized clinical trials, little is known about the long-term clinical course of treatment-seeking SUD patients with comorbid ADHD. AIMS This paper presents the protocol and baseline clinical characteristics of the International Naturalistic Cohort Study of ADHD and SUD (INCAS) designed and conducted by the International Collaboration on ADHD and Substance Abuse (ICASA) foundation. The overall aim of INCAS is to investigate the treatment modalities provided to treatment-seeking SUD patients with comorbid ADHD, and to describe the clinical course and identify predictors for treatment outcomes. This ongoing study employs a multicentre observational prospective cohort design. Treatment-seeking adult SUD patients with comorbid ADHD are recruited, at 12 study sites in nine different countries. During the follow-up period of nine months, data is collected through patient files, interviews, and self-rating scales, targeting a broad range of cognitive and clinical symptom domains, at baseline, four weeks, three months and nine months. RESULTS A clinically representative sample of 578 patients (137 females, 441 males) was enrolled during the recruitment period (June 2017-May 2021). At baseline, the sample had a mean age (SD) of 36.7 years (11.0); 47.5% were inpatients and 52.5% outpatients; The most prevalent SUDs were with alcohol 54.2%, stimulants 43.6%, cannabis 33.1%, and opioids 14.5%. Patients reported previous treatments for SUD in 71.1% and for ADHD in 56.9%. Other comorbid mental disorders were present in 61.4% of the sample: major depression 31.5%, post-traumatic stress disorder 12.1%, borderline personality disorder 10.2%. CONCLUSIONS The first baseline results of this international cohort study speak to its feasibility. Data show that many SUD patients with comorbid ADHD had never received treatment for their ADHD prior to enrolment in the study. Future reports on this study will identify the course and potential predictors for successful pharmaceutical and psychological treatment outcomes. TRIAL REGISTRATION ISRCTN15998989 20/12/2019.
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Affiliation(s)
- Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Myriam Aeschlimann
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Csaba Barta
- grid.11804.3c0000 0001 0942 9821Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
| | | | - Amanda Bäcker
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Cleo Lina Crunelle
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Constanza Daigre
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura De Fuentes-Merillas
- grid.491352.8Novadic-Kentron Addiction Care; Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Zsolt Demetrovics
- grid.5591.80000 0001 2294 6276Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary ,grid.513141.30000 0004 4670 111XCentre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Geert Dom
- grid.5284.b0000 0001 0790 3681University of Antwerp, Antwerp, Belgium ,PC Multiversum, Boechout, Belgium
| | - Lara Grau López
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Romain Icick
- grid.508487.60000 0004 7885 7602Université de Paris Cité, Paris, France
| | | | | | - Máté Kapitány-Fövény
- grid.11804.3c0000 0001 0942 9821Faculty of Health Sciences, Semmelweis University, Budapest, Hungary ,National Institute of Mental Health, Neurology and Neurosurgery – Nyírő Gyula Hospital, Budapest, Hungary
| | - Emily Karsinti
- grid.414095.d0000 0004 1797 9913Université Paris-Nanterre, CliPsyD Laboratory FR and APHP, Fernand Widal Hospital, Universitary Department of Psychiatry and Addictology, Paris, France
| | - Falk Kiefer
- grid.7700.00000 0001 2190 4373Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maija Konstenius
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Frances R. Levin
- grid.21729.3f0000000419368729Vagelos College of Physicians and Surgeons, New York City, USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York City, USA
| | - Mathias Luderer
- grid.411088.40000 0004 0578 8220Department of Psychiatry, Psychosomatic Medicine and Psychoterapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Wiebren Markus
- grid.491352.8Iriszorg Addiction Care, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Frieda Matthys
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Franz Moggi
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry, Translational Research Center, University of Bern, Bern, Switzerland
| | - Raul Felipe Palma-Alvarez
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria Paraskevopoulou
- Department of Psychiatry, RadboudumcDonders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - J. Antoni Ramos-Quiroga
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Arnt Schellekens
- Department of Psychiatry, RadboudumcDonders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands ,grid.491352.8Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Leila M. Soravia
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry, Translational Research Center, University of Bern, Bern, Switzerland ,Südhang Clinic, Kirchlindach, Switzerland
| | - Norman Therribout
- grid.414095.d0000 0004 1797 9913Université Paris-Nanterre, CliPsyD Laboratory FR and APHP, Fernand Widal Hospital, Universitary Department of Psychiatry and Addictology, Paris, France
| | - Anil Thomas
- Mt. Sinai, Icahn School of Medicine, New York City, USA ,grid.137628.90000 0004 1936 8753NYU Grossman School of Medicine, New York City, USA
| | - Geurt van de Glind
- grid.438049.20000 0001 0824 9343University of Applied Sciences-Utrecht, Utrecht, the Netherlands
| | - Michiel Willem van Kernebeek
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Sabine Vollstädt-Klein
- grid.7700.00000 0001 2190 4373Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Florence Vorspan
- grid.508487.60000 0004 7885 7602Université de Paris Cité, Paris, France
| | - Wim van den Brink
- grid.509540.d0000 0004 6880 3010Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Johan Franck
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
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24
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Mupara LM, Tapera R, Selemogwe-Matsetse M, Kehumile JT, Gaogane L, Tsholofelo E, Murambiwa P. Alcohol and substance use prevention in Africa: systematic scoping review. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2021.1941356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lucia M. Mupara
- Department of Health Promotion and Education, School of Public Health, Boitekanelo College, Gaborone, Botswana
- Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Roy Tapera
- Department of Environmental Health, School of Public health, Faculty of Health Sciences, Gaborone, Botswana
| | - Morekwe Selemogwe-Matsetse
- Department of Health Promotion and Education, School of Public Health, Boitekanelo College, Gaborone, Botswana
| | - Johanne T. Kehumile
- Department of Health Promotion and Education, School of Public Health, Boitekanelo College, Gaborone, Botswana
| | - Lebogang Gaogane
- Department of Health Promotion and Education, School of Public Health, Boitekanelo College, Gaborone, Botswana
| | - Ellen Tsholofelo
- Department of Health Promotion and Education, School of Public Health, Boitekanelo College, Gaborone, Botswana
| | - Pretty Murambiwa
- Department of Health Promotion and Education, School of Public Health, Boitekanelo College, Gaborone, Botswana
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25
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Taubin D, Wilson JC, Wilens TE. ADHD and Substance Use Disorders in Young People: Considerations for Evaluation, Diagnosis, and Pharmacotherapy. Child Adolesc Psychiatr Clin N Am 2022; 31:515-530. [PMID: 35697399 DOI: 10.1016/j.chc.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Co-occurring ADHD and substance use disorder (SUD) is a common clinical presentation associated with significant impairment requiring careful evaluation, diagnosis, and treatment. Treatment with medication, along with cognitive behavioral therapy, is generally regarded as effective in addressing symptoms and impairments associated with both disorders. Options for pharmacotherapy include stimulant and nonstimulant therapies administered with careful monitoring of dosage and compliance to optimize efficacy. In high-risk groups such as college students and/or those with SUD, prescribers should address risks of stimulant misuse and diversion through patient and family education, medication monitoring, and other risk-reducing practices.
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Affiliation(s)
- Daria Taubin
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Warren Building 628B, 55 Fruit Street, Boston, MA 02114, USA
| | - Julia C Wilson
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Warren Building 628B, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Child Psychiatry Service, Massachusetts General Hospital, 55 Fruit Street, YAW 6A, Boston, MA 02114, USA; Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
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26
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Srichawla BS, Telles CC, Schweitzer M, Darwish B. Attention Deficit Hyperactivity Disorder and Substance Use Disorder: A Narrative Review. Cureus 2022; 14:e24068. [PMID: 35573587 PMCID: PMC9097465 DOI: 10.7759/cureus.24068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) has a growing incidence and prevalence in the United States and throughout the world, much of which is contributed to increased awareness of the condition and solidified diagnostic criteria. Substance use disorder (SUD) similarly has seen a sharp increase, particularly with the rising cases of opioid abuse. Management of ADHD is done primarily with pharmacologic therapy, often stimulants and with psychosocial interventions (i.e., exercise, meditation, peer-to-peer intervention, etc.) for adjunctive management. Management of SUD involves cessation and treatment based on the underlying drug of abuse. Many clinicians are uncomfortable treating ADHD in patients with SUD based on concerns the intervention may lead to an adverse event, including drug relapse, and the development of other psychiatric comorbidities. Concerns also arise about stimulants acting as a gateway drug in adolescents leading to the onset of SUD. Thus, in this narrative review, we aim to shed light on ADHD in relation to SUD and to provide clinical insight based on the current scientific literature on the topic. ADHD causes lesions in subcortical structures in the basal ganglia and limbic system. Treatment of ADHD with stimulants has been shown to normalize malformed neuroanatomical variations and lead to improved long-term outcomes compared to non-treatment of ADHD. Based on current scientific literature, it is recommended to treat ADHD with guideline-directed pharmacologic agents including stimulants along with non-pharmacologic interventions primarily exercise. There may be some improvement in reducing risky behavior, such as substance abuse, and may even help prevent the development of SUD.
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Affiliation(s)
| | - Chloe C Telles
- Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Melanie Schweitzer
- Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Bilal Darwish
- Medicine, Idaho College of Osteopathic Medicine, Meridian, USA
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27
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Kantak KM. Rodent models of attention-deficit hyperactivity disorder: An updated framework for model validation and therapeutic drug discovery. Pharmacol Biochem Behav 2022; 216:173378. [DOI: 10.1016/j.pbb.2022.173378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 01/21/2023]
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28
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Sabbe M, Sawchik J, Gräfe M, Wuillaume F, De Bruyn S, Van Antwerpen P, Van Hal G, Desseilles M, Hamdani J, Malonne H. Use and misuse of prescription stimulants by university students: a cross-sectional survey in the french-speaking community of Belgium, 2018. Arch Public Health 2022; 80:54. [PMID: 35168683 PMCID: PMC8848864 DOI: 10.1186/s13690-022-00816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Misuse of prescription stimulants (PS) has been reported among students to enhance academic performance in Flanders (Belgium). However, PS misuse among students in the French-speaking community is unknown. The main purpose of the study was to estimate the prevalence of medical use and misuse of PS by university students in the French-speaking community (Belgium), and to investigate the reasons and sources associated with PS misuse. Methods A cross-sectional online survey was performed in 2018. All university students 18 years and older were invited to participate and asked about PS use, including medical (i.e., used for therapeutic purposes) and nonmedical reasons and sources of PS. Results In total, 12 144 students participated in the survey (median age = 21 years, 65.5% female). The estimated prevalence of PS use was 6.9% (ever use) and 5.5% (past-year). Among ever users, 34.7% were classified as medical users and 65.3% as misusers. Lifetime prevalence of misuse was estimated at 4.5%. The most common reason for medical use was treatment of attention disorder (85.9%). Reasons for misuse were mainly to improve concentration (76.1%) or to stay awake and study longer (50.7%). Friends or acquaintances inside the student community and general practitioners were the main sources of PS for misuse (41.5% and 23.5%, respectively). Conclusions This study found that rates of misuse of PS in French-speaking universities in Belgium were in line with studies conducted in Flanders and Europe. Academic institutions can use these results to tailor their drug prevention campaigns.
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Affiliation(s)
- Martine Sabbe
- Scientific Directorate of Epidemiology and public health - Sciensano, Brussels, Belgium. .,DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium.
| | - Javier Sawchik
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Mégane Gräfe
- Unit of Pharmacology, Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Université libre de Bruxelles, Brussels, Belgium
| | - Françoise Wuillaume
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Sara De Bruyn
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Antwerpen
- RD3-Pharmacognosy, Bioanalysis and Drug Discovery- Faculty of Pharmacy, Université libre de Bruxelles, Brussels, Belgium
| | - Guido Van Hal
- Unit of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | | | - Jamila Hamdani
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Hugues Malonne
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium.,Unit of Pharmacology, Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Université libre de Bruxelles, Brussels, Belgium.,Department of Biomedical Sciences, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
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Therribout N, Karsinti E, Morel A, Dereux A, Vorspan F, Romo L, Icick R. Feasibility of an Extensive Strategy for Adult Diagnosis of Attention Deficit Hyperactivity Disorder Among Patients Suffering From Substance Use Disorders. Front Psychiatry 2022; 13:803227. [PMID: 35836660 PMCID: PMC9273821 DOI: 10.3389/fpsyt.2022.803227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Attention Deficit Hyperactivity Disorder (ADHD) is found in up to 20% adults with Substance Use Disorder (SUD). ADHD + SUD is associated with a more complex clinical presentation and poorer outcomes than each disorder alone. In the presence of SUD, adult ADHD is particularly difficult to diagnose as both disorders can mimic or hide the symptoms of each other. Our university hospital in Paris recently started an extensive outpatient diagnostic procedure for adult patients with SUD to ascertain or refute ADHD diagnosis and to provide therapeutic guidance. Here, we report the acceptability of the assessment procedure for patients and the preliminary description of the current and lifetime clinical profiles as a function of the final diagnosis "ADHD vs. no ADHD." METHOD Adult SUD patients with suspected ADHD were included in the current pilot study after stating they had no objection that their de-identified data were used for research purposes, according to French ethical procedures. Patients were evaluated for ADHD, comorbid mental disorders, cognitive state and dimensional psychological variables. They were assessed by trained psychologists and psychiatrists using standardized tools over a day. ADHD diagnosis was mainly based on the Diagnostisch Interview Voor ADHD for DSM-5 (DIVA-5). RESULTS Out of 18 eligible patients, 17 were included in the cohort (1 excluded) and none was opposed to using their data. Thirteen (76%) participants were diagnosed with ADHD. All patients appointed for the ADHD diagnostic procedure came, respected schedules and finished the evaluation. All patients were impaired on cognitive functioning and were highly comorbid, but ADHD patients seems to suffer even more from those conditions, especially for cannabis and stimulant use disorders. DISCUSSION Preliminary results show high acceptability of the procedure by ADHD-SUD patients. This result could be explained by all the organization adapted to the psychopathology. Patients' baseline motivation to participate also represents an uncontrolled variable that could promote the ability to follow the procedure. Acceptance results of the protocol are promising and represent a starting point to identify the best procedures to design patient-centered pharmacological and non-pharmacological therapies.
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Affiliation(s)
- Norman Therribout
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,Laboratoire Clipsyd EA 4430, Université Paris-Nanterre, Nanterre, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Emily Karsinti
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,Laboratoire Clipsyd EA 4430, Université Paris-Nanterre, Nanterre, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Alix Morel
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Alexandra Dereux
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Florence Vorspan
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Lucia Romo
- Laboratoire Clipsyd EA 4430, Université Paris-Nanterre, Nanterre, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.,CESP, U1018 INSERM UPS UVSQ, Villejuif, France
| | - Romain Icick
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
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30
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Cavicchioli M, Ogliari A, Movalli M, Maffei C. Persistent Deficits in Self-Regulation as a Mediator between Childhood Attention-Deficit/Hyperactivity Disorder Symptoms and Substance Use Disorders. Subst Use Misuse 2022; 57:1837-1853. [PMID: 36096483 DOI: 10.1080/10826084.2022.2120358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) has been largely demonstrated. Some scholars have hypothesized that self-regulation mechanisms might play a key role in explaining this association. Objective(s): The current study tested the hypothesis that retrospective childhood ADHD symptoms might lead to more severe SUDs and this association should be mediated by current self-ratings of behavioral disinhibition, inattention, and emotional dysregulation among 204 treatment-seeking adults (male: 67.3%; female: 32.7%) with a primary diagnosis of alcohol use disorder and other SUDs. Methods: The mediational model was estimated through self-report measures of childhood ADHD symptoms (independent variable; WURS), current self-regulation mechanisms (mediators)-behavioral disinhibition (BIS-11 motor subscale), difficulties with attention regulation (MAAS) and emotion regulation (DERS)-and severity of SUDs (dependent variable; SPQ alcohol, illicit and prescribed drugs). Results: The analysis showed that alterations in the self-regulation system fully mediated the association between the severity of childhood ADHD symptoms and SUDs in adulthood. Behavioral disinhibition and difficulties in attention regulation were the most representative alterations in self-regulation processes that explained this association. Conclusions: These findings suggest it is useful to implement several therapeutic approaches (e.g. behavioral, mindfulness-based, and pharmacological) to increase the self-regulation abilities of children and adolescents with ADHD in order to reduce the probability of SUD onset in adulthood. However, future longitudinal neuroimaging and neuropsychological studies are needed to further support the role of self-regulation mechanisms in explaining the prospective association between childhood ADHD symptoms and SUDs in adulthood.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Anna Ogliari
- Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.,Child in Mind Lab, University "Vita-Salute San Raffaele", Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
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31
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Identifying and Managing Eating Disorders in Persons Presenting for Addiction Treatment. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Oliva F, Mangiapane C, Nibbio G, Berchialla P, Colombi N, Vigna-Taglianti FD. Prevalence of cocaine use and cocaine use disorder among adult patients with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. J Psychiatr Res 2021; 143:587-598. [PMID: 33199055 DOI: 10.1016/j.jpsychires.2020.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
We conducted this systematic review and meta-analysis (registered with PROSPERO CRD42020142039) of the literature to estimate the lifetime prevalence of cocaine use and cocaine use disorder among adult patients with attention-deficit/hyperactivity disorder (ADHD). The literature search was performed on the electronic databases PubMed and PsychINFO without date or language restrictions. Additional studies were identified by hand searching of citations. Inclusion criteria were: studies involving adult patients with ADHD and reporting cocaine use and/or cocaine use disorders. Data were pooled in the meta-analyses using a generalized linear mixed model with random effects. Statistical heterogeneity was assessed using the Cochran Q test. Sensitivity analyses were conducted. Twelve studies were included in the review: six in the meta-analysis of cocaine use and nine in the meta-analysis of cocaine use disorder. The estimated prevalence of cocaine use was 26.0% (95% CI 0.18-0.35) and the estimated prevalence of cocaine use disorder was 10.0% (95% CI 0.08-0.13). Heterogeneity in both meta-analyses was high but decreased to non-significance in the meta-analysis on cocaine use disorder after excluding the outlier study. In conclusion, one out of four adult patients with ADHD use cocaine and one out of ten develop a lifetime cocaine use disorder. Since cocaine use can lead to more severe and complex disorders of impaired systemic functioning, adult patients with ADHD should be assessed for cocaine use disorder and promptly referred for treatment.
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Affiliation(s)
- F Oliva
- Department of Clinical and Biological Sciences, University of Torino, Italy
| | - C Mangiapane
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Italy
| | - G Nibbio
- Department of Psychiatry, Brescia University School of Medicine, Brescia, Italy
| | - P Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Italy
| | - N Colombi
- Federated Library of Medicine "F. Rossi", University of Torino, Italy
| | - F D Vigna-Taglianti
- Department of Clinical and Biological Sciences, University of Torino, Italy; Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Torino, Italy.
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33
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Lam AP, Moeller S, Speitling C, Lam MC, Philipsen A, Müller HHO. Consumption of Synthetic Cannabinoids in Adult Attention-Deficit/Hyperactivity Disorder: a Pilot Study. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00248-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AbstractAttention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for substance abuse and addiction. Synthetic cannabinoids (SC) have gained rising importance as their consumption increased rapidly in the last few years. However, SC consumption in patients with adult ADHD has not been investigated yet. A prospective clinical pilot study was conducted, including 60 adults with ADHD, assessing the prevalence of SC consumption and its associations with psychiatric comorbidities and patient characteristics. A drug consumption survey was utilized to investigate the use of SC and other drugs. Current ADHD symptoms were evaluated via ADHD Self-Rating Scale (ADHD-SR) and retrospective childhood ADHD symptom severity via Wender Utah Rating Scale (WURS-k) questionnaire. A positive lifetime prevalence of SC consumption was found in 15.0% of the analyzed sample. SC consumption was significantly associated with current smoking, lifetime use of natural cannabis (NC), cocaine, amphetamines, and benzodiazepines. Lifetime NC consumption was indicated by 65.0% and found to antecede SC use in adult ADHD patients. Logistic regression analysis identified substance use disorder and male sex as predictive for SC consumption. Patients with history of SC use scored significantly higher in both WURS-k and ADHD-SR questionnaire compared with nonusers and suffered significantly more frequently from psychiatric comorbidities. Main side-effects of SC included gastrointestinal, cardiovascular, and neuropsychiatric symptoms. SC consumption in adults with ADHD is frequent and associated with stronger ADHD symptom severity. Given the underestimated dangerous effects and related comorbidities, SC use should be subject to scrutiny by clinicians treating ADHD patients. More studies are needed to further elucidate the impact of SC use in ADHD.
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34
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Jaeschke RR, Sujkowska E, Sowa-Kućma M. Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology (Berl) 2021; 238:2667-2691. [PMID: 34436651 PMCID: PMC8455398 DOI: 10.1007/s00213-021-05946-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/31/2021] [Indexed: 12/12/2022]
Abstract
RATIONALE Psychostimulants, including methylphenidate (MPH), are the mainstay of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) in adults. Even though MPH is the most commonly used medication for ADHD these days, there are relatively few resources available that provide comprehensive insight into the pharmacological and clinical features of the compound. OBJECTIVE The aim of this paper is to provide an up-to-date outline of the pharmacology and clinical utility of MPH for ADHD in adult patients. METHODS While conducting the narrative review, we applied structured search strategies covering the two major online databases (MEDLINE and Cochrane Central Register of Controlled Trials). In addition, we performed handsearching of reference lists of relevant papers. RESULTS Methylphenidate exhibits multimodal mechanism of action, working primarily as a dopamine and noradrenaline reuptake inhibitor. It also protects the dopaminergic system against the ongoing 'wearing off' (by securing a substantial reserve pool of the neurotransmitter, stored in the presynaptic vesicles). In placebo-controlled trials, MPH was shown to be moderately effective both against the core ADHD symptoms (standardized mean difference [SMD], 0.49; 95% confidence interval [CI], 0.35-0.64), and the accompanying emotion regulation deficits (SMD, 0.34; 95% CI, 0.23-0.45). The most common adverse events related to long-term treatment with MPH are decreased appetite (~ 20%), dry mouth (15%), heart palpitations (13%), gastrointestinal infections (~ 10%), and agitation/feeling restless (~ 10%). CONCLUSIONS There is substantial body of evidence to suggest that MPH is an effective and safe treatment option for adults with ADHD.
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Affiliation(s)
- Rafał R Jaeschke
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501, Kraków, Poland.
| | - Ewelina Sujkowska
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszów University, ul. Kopisto 2a, 35-315, Rzeszów, Poland
| | - Magdalena Sowa-Kućma
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszów University, ul. Kopisto 2a, 35-315, Rzeszów, Poland
- Centre for Innovative Research in Medical and Natural Sciences, Medical College of Rzeszów University, ul. Warzywna 1a, 35-310, Rzeszów, Poland
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35
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Vink JM, Treur JL, Pasman JA, Schellekens A. Investigating genetic correlation and causality between nicotine dependence and ADHD in a broader psychiatric context. Am J Med Genet B Neuropsychiatr Genet 2021; 186:423-429. [PMID: 32909657 PMCID: PMC9292706 DOI: 10.1002/ajmg.b.32822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/26/2019] [Accepted: 08/12/2020] [Indexed: 12/28/2022]
Abstract
People with attention-deficit/hyperactivity disorder (ADHD) or other psychiatric disorders show high rates of nicotine dependence (ND). This comorbidity might be (partly) explained by shared genetic factors. Genetic correlations between ND and ADHD (or other psychiatric disorders) have not yet been estimated. A significant genetic correlation might indicate genetic overlap, but could also reflect a causal relationship. In the present study we investigated the genetic correlation (with LD score regression analyses) between ND and ADHD, as well as between ND and other major psychiatric conditions (major depressive disorder, schizophrenia, anxiety, bipolar disorder, autism spectrum, anorexia nervosa, and antisocial behavior) based on the summary statistics of large Genome Wide Association studies. We explored the causal nature of the relationship between ND and ADHD using two-sample Mendelian randomization. We found a high genetic correlation between ND and ADHD (rg = .53, p = 1.85 × 10-13 ), and to a lesser extent also between ND-major depressive disorder (rg = .42, p = 3.6 × 10-11 ) and ND-schizophrenia (rg = .18, p = 1.1 × 10-3 ). We did not find evidence for a causal relationship from liability for ADHD to ND (which could be due to a lack of power). The strong genetic correlations might reflect different phenotypic manifestations of (partly) shared underlying genetic vulnerabilities. Combined with the lack of evidence for a causal relationship from liability for ADHD to ND, these findings stress the importance to further investigate the underlying genetic vulnerability explaining co-morbidity in psychiatric disorders.
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Affiliation(s)
| | - Jorien L. Treur
- Department of Psychiatry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Joëlle A. Pasman
- Behavioural Science InstituteRadboud UniversityNijmegenThe Netherlands
| | - Arnt Schellekens
- Department of PsychiatryRadoudumc, Donders Centre for Medical NeuroscienceNijmegenThe Netherlands,Nijmegen Institute for Scientist Practitioners in AddictionNijmegenThe Netherlands
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36
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Karlsson AT, Vederhus JK, Clausen T, Weimand B, Solli KK, Tanum L. Levels of Impulsivity, Hyperactivity, and Inattention and the Association with Mental Health and Substance Use Severity in Opioid-Dependent Patients Seeking Treatment with Extended-Release Naltrexone. J Clin Med 2021; 10:jcm10194558. [PMID: 34640572 PMCID: PMC8509800 DOI: 10.3390/jcm10194558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 01/10/2023] Open
Abstract
The level of impulsivity, hyperactivity, and inattention (IHI) is higher among patients with substance use disorder (SUD) than in the general population. However, the prevalence of such symptoms in patients seeking treatment with an opioid antagonist, such as extended-release naltrexone (XR-NTX), is unknown. We screened 162 patients with opioid use disorder (OUD) seeking treatment with XR-NTX in Norway using the Adult ADHD Self-Report Scale (ASRS) to estimate the prevalence of IHI alongside an assessment of mental and physical health and substance use. Sixty-six patients scored above the clinical cut-off on the ASRS. Higher levels of IHI were significantly associated with a longer history of frequent amphetamine use, current alcohol use, and greater mental distress. Mental distress was the strongest factor associated with higher levels of IHI. The introduction of screening for IHI and mental distress in opioid maintenance treatment and XR-NTX would likely improve the quality of care and enable clinicians to tailor interventions to the needs of patients with high levels of IHI to prevent treatment discontinuation.
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Affiliation(s)
- Ann Tarja Karlsson
- Addiction Unit, Sørlandet Hospital HF, 4604 Kristiansand, Norway; (J.-K.V.); (T.C.)
- Correspondence: ; Tel.: +47-381-32-600
| | - John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, 4604 Kristiansand, Norway; (J.-K.V.); (T.C.)
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, 4604 Kristiansand, Norway; (J.-K.V.); (T.C.)
- Norwegian Centre for Addiction Research, University of Oslo, 0315 Oslo, Norway;
| | - Bente Weimand
- Mental Health Services, Akershus University Hospital, Lørenskog, 1478 Oslo, Norway;
- Center for Mental Health and Substance Abuse, University of South-Eastern Norway, 3040 Drammen, Norway
| | - Kristin Klemmetsby Solli
- Norwegian Centre for Addiction Research, University of Oslo, 0315 Oslo, Norway;
- Vestfold Hospital Trust, 3103 Toensberg, Norway
- Department of R&D in Psychiatric Health Care, Akershus University Hospital, 1478 Oslo, Norway;
| | - Lars Tanum
- Department of R&D in Psychiatric Health Care, Akershus University Hospital, 1478 Oslo, Norway;
- Faculty for Health Science, Oslo Metropolitan University, 0130 Oslo, Norway
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Widinghoff C, Berge J, Hakansson A. Psychiatric Drug Prescription and Temporal Associations with a First Diagnosis of Gambling Disorder—Results from a National Register Study. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00636-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractPsychiatric comorbidity is common in gambling disorder (GD), but there are few studies on larger nationwide samples of treatment-seeking patients. Also, temporal associations between GD and other psychiatric disorders are often difficult to study. To address the prevalence and the temporal associations of prescriptions for psychiatric disorders — both in specialized care and primary care — in patients with a GD diagnosis (ICD-10 F63.0). Data was derived from national health registers in Sweden. All patients who were diagnosed with GD in specialized health care in 2005–2016 were included and run against the nationwide database on prescription of pharmaceuticals aimed for psychiatric disorders (n = 2018). Prevalence of psychiatric drug prescription was used as a proxy for psychiatric comorbidity and studied for two 2-year periods (period 1 and 2) prior to GD and one 2-year period (period 3) after the diagnosis. Controlling for gender, age, and time periods, for eight drug categories (anti- epileptics, anti-psychotics, benzodiazepine derivatives, anxiolytics, hypnotics, anti- depressants and drugs used in addictive disorders), significant increases in drug prescription were seen. For central stimulants, a significant increase was seen upon receiving the GD diagnosis (from period 2 to 3), and for benzodiazepines, an increase was seen prior to the GD diagnosis (from period 1 to 2), but not upon diagnosis (from period 2 to 3). Psychiatric comorbidity in GD is common. Drug prescription for psychiatric problems increased markedly in the years temporarily associated with a first diagnosis of GD. The findings may call for early screening for problem gambling in patients with treatment contacts for increasingly poor mental health.
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Brikell I, Wimberley T, Albiñana C, Pedersen EM, Vilhjálmsson BJ, Agerbo E, Demontis D, Børglum AD, Schork AJ, LaBianca S, Werge T, Mors O, Hougaard DM, Thapar A, Mortensen PB, Dalsgaard S. Genetic, Clinical, and Sociodemographic Factors Associated With Stimulant Treatment Outcomes in ADHD. Am J Psychiatry 2021; 178:854-864. [PMID: 34154395 PMCID: PMC10951468 DOI: 10.1176/appi.ajp.2020.20121686] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Stimulant medications are effective for treating attention deficit hyperactivity disorder (ADHD), yet discontinuation and switch to nonstimulant ADHD medications are common. This study aimed to identify genetic, clinical, and sociodemographic factors influencing stimulant treatment initiation, discontinuation, and switch to nonstimulants in individuals with ADHD. METHODS The authors obtained genetic and national register data for 9,133 individuals with ADHD from the Danish iPSYCH2012 sample and defined stimulant treatment initiation, discontinuation, and switch from prescriptions. For each stimulant treatment outcome, they examined associations with polygenic risk scores (PRSs) for psychiatric disorders and clinical and sociodemographic factors using survival analyses, and conducted genome-wide association studies (GWASs) and estimated single-nucleotide polymorphism heritability (h2SNP). RESULTS Eighty-one percent of the sample initiated stimulant treatment. Within 2 years, 45% discontinued stimulants and 15% switched to nonstimulants. Bipolar disorder PRS (hazard ratio=1.05, 95% CI=1.02, 1.09) and schizophrenia PRS (hazard ratio=1.07, 95% CI=1.03, 1.11) were associated with discontinuation. Depression, bipolar disorder, and schizophrenia PRSs were marginally but not significantly associated with switch (hazard ratio range, 1.05-1.07). No associations were observed for ADHD and autism PRSs. Individuals diagnosed with ADHD at age 13 or older had higher rates of stimulant initiation, discontinuation, and switch (hazard ratio range, 1.27-2.01). Psychiatric comorbidities generally reduced rates of initiation (hazard ratio range, 0.84-0.88) and increased rates of discontinuation (hazard ratio range, 1.19-1.45) and switch (hazard ratio range, 1.40-2.08). h2SNP estimates were not significantly different from zero. No GWAS hits were identified for stimulant initiation or discontinuation. A locus on chromosome 16q23.3 reached genome-wide significance for switch. CONCLUSIONS The study findings suggest that individuals with ADHD with higher polygenic liability for mood and/or psychotic disorders, delayed ADHD diagnosis, and psychiatric comorbidities have a higher risk for stimulant treatment discontinuation and switch to nonstimulants. Despite the study's limited sample size, one putative GWAS hit for switch was identified, illustrating the potential of utilizing genomics linked to prescription databases to advance ADHD pharmacogenomics.
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Affiliation(s)
- Isabell Brikell
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Theresa Wimberley
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Clara Albiñana
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Emil Michael Pedersen
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Bjarni Jóhann Vilhjálmsson
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Ditte Demontis
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Department of Biomedicine and Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Central Region Denmark and Aarhus University, Aarhus, Denmark
| | - Anders D. Børglum
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Department of Biomedicine and Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Central Region Denmark and Aarhus University, Aarhus, Denmark
| | - Andrew J. Schork
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Neurogenomics Division, The Translational Genomics Research Institute (TGEN), Phoenix, AZ, USA
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sonja LaBianca
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Werge
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Denmark
| | - David M. Hougaard
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Child and Adolescent Psychiatry, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, Wales
| | - Preben Bo Mortensen
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Søren Dalsgaard
- iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- NCRR - National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
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39
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Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MMJ, Asherson P, Atwoli L, Bölte S, Buitelaar JK, Crunelle CL, Daley D, Dalsgaard S, Döpfner M, Espinet S, Fitzgerald M, Franke B, Gerlach M, Haavik J, Hartman CA, Hartung CM, Hinshaw SP, Hoekstra PJ, Hollis C, Kollins SH, Sandra Kooij JJ, Kuntsi J, Larsson H, Li T, Liu J, Merzon E, Mattingly G, Mattos P, McCarthy S, Mikami AY, Molina BSG, Nigg JT, Purper-Ouakil D, Omigbodun OO, Polanczyk GV, Pollak Y, Poulton AS, Rajkumar RP, Reding A, Reif A, Rubia K, Rucklidge J, Romanos M, Ramos-Quiroga JA, Schellekens A, Scheres A, Schoeman R, Schweitzer JB, Shah H, Solanto MV, Sonuga-Barke E, Soutullo C, Steinhausen HC, Swanson JM, Thapar A, Tripp G, van de Glind G, van den Brink W, Van der Oord S, Venter A, Vitiello B, Walitza S, Wang Y. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev 2021; 128:789-818. [PMID: 33549739 PMCID: PMC8328933 DOI: 10.1016/j.neubiorev.2021.01.022] [Citation(s) in RCA: 411] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, Psychiatry Research Division, SUNY Upstate Medical University, Syracuse, NY, USA; World Federation of ADHD, Switzerland; American Professional Society of ADHD and Related Disorders (APSARD), USA.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Child and Adolescent Psychiatrist's Representative, Zentrales-ADHS-Netz, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing, China; Beijing Key Laboratory of Mental Disorders, Beijing, China; Beijing Institute for Brain Disorders, Beijing, China; Asian Federation of ADHD, China; Chinese Society of Child and Adolescent Psychiatry, China
| | - Joseph Biederman
- Clinical & Research Programs in Pediatric Psychopharmacology & Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Jeffrey H Newcorn
- American Professional Society of ADHD and Related Disorders (APSARD), USA; Departments of Psychiatry and Pediatrics, Division of ADHD and Learning Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin Gignac
- Department of Child and Adolescent Psychiatry, Montreal Children's Hospital, MUHC, Montreal, Canada; Child and Adolescent Psychiatry Division, McGill University, Montreal, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | | | - Iris Manor
- Chair, Israeli Society of ADHD (ISA), Israel; Co-chair of the neurodevelopmental section in EPA (the European Psychiatric Association), France
| | - Luis Augusto Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
| | - Li Yang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton,UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; University of Nottingham, Nottingham, UK
| | - Doron Almagor
- University of Toronto, SickKids Centre for Community Mental Health, Toronto, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | - Mark A Stein
- University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Turki H Albatti
- Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Haya F Aljoudi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Mohammed M J Alqahtani
- Clinical Psychology, King Khalid University, Abha, Saudi Arabia; Saudi ADHD Society, Saudi Arabia
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Science, Moi University School of Medicine, Eldoret, Kenya; Brain and Mind Institute, and Department of Internal Medicine, Medical College East Africa, the Aga Khan University, Kenya; African College of Psychopharmacology, Kenya; African Association of Psychiatrists, Kenya
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cleo L Crunelle
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Dept. of Psychiatry, Brussel, Belgium; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine University of Nottingham, Nottingham, UK; NIHR MindTech Mental Health MedTech Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany; Zentrales-ADHS-Netz, Germany
| | | | | | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Professional Board, ADHD Europe, Belgium
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, Groningen, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; ADHD Across the Lifespan Network from European College of Neuropsychopharmacology(ECNP), the Netherlands
| | | | - Stephen P Hinshaw
- University of California, Berkeley, CA, USA; University of California, San Francisco, CA, USA
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Chris Hollis
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK; NIHR MindTech MedTech Co-operative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Scott H Kollins
- Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - J J Sandra Kooij
- Amsterdam University Medical Center (VUMc), Amsterdam, the Netherlands; PsyQ, The Hague, the Netherlands; European Network Adult ADHD, the Netherlands; DIVA Foundation, the Netherlands; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tingyu Li
- Growth, Development and Mental Health Center for Children and Adolescents, Children's Hospital of Chongqing Medical University, Chongqing, China; National Research Center for Clinical Medicine of Child Health and Disease, Chongqing, China; The Subspecialty Group of Developmental and Behavioral Pediatrics, the Society of Pediatrics, Chinese Medical Association, China
| | - Jing Liu
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; The Chinese Society of Child and Adolescent Psychiatry, China; The Asian Society for Child and Adolescent Psychiatry and Allied Professions, China
| | - Eugene Merzon
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel; Israeli Society of ADHD, Israel; Israeli National Diabetes Council, Israel
| | - Gregory Mattingly
- Washington University, St. Louis, MO, USA; Midwest Research Group, St Charles, MO, USA
| | - Paulo Mattos
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brazilian Attention Deficit Association (ABDA), Brazil
| | | | | | - Brooke S G Molina
- Departments of Psychiatry, Psychology, Pediatrics, Clinical & Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel T Nigg
- Center for ADHD Research, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Diane Purper-Ouakil
- University of Montpellier, CHU Montpellier Saint Eloi, MPEA, Medical and Psychological Unit for Children and Adolescents (MPEA), Montpellier, France; INSERM U 1018 CESP-Developmental Psychiatry, France
| | - Olayinka O Omigbodun
- Centre for Child & Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Child & Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Yehuda Pollak
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Israel; The Israeli Society of ADHD (ISA), Israel
| | - Alison S Poulton
- Brain Mind Centre Nepean, University of Sydney, Sydney, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Ravi Philip Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany; German Psychiatric Association, Germany
| | - Katya Rubia
- World Federation of ADHD, Switzerland; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany
| | - Julia Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany; Zentrales-ADHS-Netz, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France; International Collaboration on ADHD and Substance Abuse (ICASA), the Netherlands; DIVA Foundation, the Netherlands
| | - Arnt Schellekens
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Renata Schoeman
- University of Stellenbosch Business School, Cape Town, South Africa; South African Special Interest Group for Adult ADHD, South Africa; The South African Society of Psychiatrists/Psychiatry Management Group Management Guidelines for ADHD, South Africa; World Federation of Biological Psychiatry, Germany; American Psychiatric Association, USA; Association for NeuroPsychoEconomics, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Henal Shah
- Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Mary V Solanto
- The Zucker School of Medicine at Hofstra-Northwell, Northwell Health, Hemstead, NY, USA; Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), USA; American Professional Society of ADHD and Related Disorders (APSARD), USA; National Center for Children with Learning Disabilities (NCLD), USA
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| | - César Soutullo
- American Professional Society of ADHD and Related Disorders (APSARD), USA; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany; Louis A. Faillace MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hans-Christoph Steinhausen
- University of Zurich, CH, Switzerland; University of Basel, CH, Switzerland; University of Southern Denmark, Odense, Denmark; Centre of Child and Adolescent Mental Health, Copenhagen, Denmark
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Wales, UK
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Geurt van de Glind
- Hogeschool van Utrecht/University of Applied Sciences, Utrecht, the Netherlands
| | - Wim van den Brink
- Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Saskia Van der Oord
- Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; European ADHD Guidelines Group, Germany
| | - Andre Venter
- University of the Free State, Bloemfontein, South Africa
| | - Benedetto Vitiello
- University of Torino, Torino, Italy; Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Yufeng Wang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
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40
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Özgen H, Spijkerman R, Noack M, Holtmann M, Schellekens ASA, van de Glind G, Banaschewski T, Barta C, Begeman A, Casas M, Crunelle CL, Daigre Blanco C, Dalsgaard S, Demetrovics Z, den Boer J, Dom G, Eapen V, Faraone SV, Franck J, González RA, Grau-López L, Groenman AP, Hemphälä M, Icick R, Johnson B, Kaess M, Kapitány-Fövény M, Kasinathan JG, Kaye SS, Kiefer F, Konstenius M, Levin FR, Luderer M, Martinotti G, Matthys FIA, Meszaros G, Moggi F, Munasur-Naidoo AP, Post M, Rabinovitz S, Ramos-Quiroga JA, Sala R, Shafi A, Slobodin O, Staal WG, Thomasius R, Truter I, van Kernebeek MW, Velez-Pastrana MC, Vollstädt-Klein S, Vorspan F, Young JT, Yule A, van den Brink W, Hendriks V. [International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 50:54-67. [PMID: 34397296 DOI: 10.1024/1422-4917/a000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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Affiliation(s)
- Heval Özgen
- Diese Autor_innen haben zu gleichen Teilen zu diesem Beitrag beigetragen.,Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande.,Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Niederlande
| | - Renske Spijkerman
- Diese Autor_innen haben zu gleichen Teilen zu diesem Beitrag beigetragen.,Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande
| | - Moritz Noack
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Deutschland
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Deutschland
| | - Arnt S A Schellekens
- Department of Psychiatry, Donders institute, Radboud UMC, Nijmegen, Niederlande.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud UMC, Nijmegen, Niederlande
| | - Geurt van de Glind
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud UMC, Nijmegen, Niederlande.,International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, Niederlande
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - Csaba Barta
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Ungarn.,Institute of Psychology, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Ungarn
| | | | - Miguel Casas
- Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spanien
| | - Cleo L Crunelle
- Department of Psychiatry, University Hospital Brussels, Brüssel, Belgien
| | - Constanza Daigre Blanco
- Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spanien.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien
| | - Søren Dalsgaard
- Department of Economics and Business Economics, Aarhus University, Aarhus, Dänemark
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerpen, Belgien
| | - Valsamma Eapen
- Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, New South Wales, Australien
| | - Stephen V Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Johan Franck
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Rafael A González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, Vereinigtes Königreich.,East London NHS Foundation Trust, Child and Adolescent Mental Health Service (CAMHS) - ADHD clinic, London, Vereinigtes Königreich
| | - Lara Grau-López
- Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spanien.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spanien
| | - Annabeth P Groenman
- Department of Psychology, University of Amsterdam, Amsterdam, Niederlande.,Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Niederlande
| | - Malin Hemphälä
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Romain Icick
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, Frankreich.,INSERM U1144, Paris, Frankreich.,Inserm UMR-S1144, Université de Paris, Paris, Frankreich
| | - Brian Johnson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Michael Kaess
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz.,Klinik für Kinder- und Jugendpsychiatrie, Zentrum für psychosoziale Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Máté Kapitány-Fövény
- Faculty of Health Sciences, Semmelweis University, Budapest, Ungarn.,Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Ungarn
| | - John G Kasinathan
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australien
| | - Sharlene S Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australien
| | - Falk Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - Maija Konstenius
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Frances R Levin
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York, USA
| | - Mathias Luderer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt am Main, Deutschland
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italien
| | - Frieda I A Matthys
- Department of Psychiatry, UZ Brussel, Vrije Universiteit Brussel (VUB), Brüssel, Belgien
| | - Gergely Meszaros
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Ungarn
| | - Franz Moggi
- Universitätsklinik für Psychiatrie, Universität Bern, Bern, Schweiz
| | - Ashmita P Munasur-Naidoo
- Department of Pharmacy, Nelson Mandela University, Port Elizabeth, Südafrika.,Cipla Medpro Pharmaceuticals, Durban, Südafrika
| | - Marianne Post
- Brijder Youth Addiction Treatment, Parnassia Psychiatric Institute, Den Haag, Niederlande
| | - Sharon Rabinovitz
- School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel
| | - J Antoni Ramos-Quiroga
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spanien.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spanien
| | - Regina Sala
- Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, Vereinigtes Königreich
| | - Abu Shafi
- East London NHS Foundation Trust, London, Vereinigtes Königreich
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Beer-Sheva, Israel
| | - Wouter G Staal
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Niederlande.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Niederlande
| | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, Südafrika
| | - Michiel W van Kernebeek
- Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brüssel, Belgien
| | | | - Sabine Vollstädt-Klein
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - Florence Vorspan
- INSERM U1144, Paris, Frankreich.,Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Paris, Frankreich.,Faculté de Médecine, Université de Paris, Paris, Frankreich.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, Frankreich
| | - Jesse T Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australien.,Murdoch Children's Research Institute, Melbourne, Victoria, Australien.,School of Population and Global Health, The University of Western Australia, Perth, Washington, Australien.,National Drug Research Institute, Curtin University, Perth, Washington, Australien
| | - Amy Yule
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Wim van den Brink
- International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, Niederlande.,Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Niederlande
| | - Vincent Hendriks
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande.,Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Niederlande
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41
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Fuller-Thomson E, Lewis DA, Agbeyaka S. Attention-Deficit/Hyperactivity Disorder and Alcohol and Other Substance Use Disorders in Young Adulthood: Findings from a Canadian Nationally Representative Survey. Alcohol Alcohol 2021; 57:385-395. [PMID: 34343246 DOI: 10.1093/alcalc/agab048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 12/31/2022] Open
Abstract
AIM (a) To document the prevalence and odds of (i) alcohol use disorders, (ii) cannabis use disorders, (iii) other drug use disorders and (iv) any substance use disorder (SUD), among young adults with and without ADHD, and (b) to investigate the degree to which the association between ADHD and SUDs is attenuated by socio-demographics, early adversities and mental health. METHOD Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (CCHS-MH). The sample included 6872 respondents aged 20-39, of whom 270 had ADHD. The survey response rate was 68.9%. MEASUREMENTS Substance Use Disorder: World Health Organization's Composite International Diagnostic Interview criteria, SUDs, were derived from lifetime algorithms for alcohol, cannabis and other substance abuse or dependence. ADHD was based on self-report of a health professional's diagnosis. FINDINGS One in three young adults with ADHD had a lifetime alcohol use disorder (36%) compared to 19% of those without ADHD (P < 0.001). After adjusting for all control variables, those with ADHD had higher odds of developing alcohol use disorders (OR = 1.38, 95% CI: 1.05, 1.81), cannabis use disorders (OR = 1.46, 95% CI: 1.06, 2.00), other drug use disorders (OR = 2.07, 95% CI: 1.46, 2.95) and any SUD (OR = 1.69, 95% CI: 1.28, 2.23). History of depression and anxiety led to the largest attenuation of the ADHD-SUD relationship, followed by childhood adversities and socioeconomic status. CONCLUSIONS Young adults with ADHD have a high prevalence of alcohol and other SUDs. Targeted outreach and interventions for this extremely vulnerable population are warranted.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W., Toronto, Canada.,Department of Family and Community Medicine, 500 University Avenue, 5th Floor University of Toronto, Toronto, Canada.,Institute for Life Course & Aging, University of Toronto, 246 Bloor St. W., Toronto, Canada
| | - Danielle A Lewis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W., Toronto, Canada
| | - Senyo Agbeyaka
- Toronto General Hospital, 200 Elizabeth St, University Health Network, Toronto, ON, Canada
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Luderer M, Ramos Quiroga JA, Faraone SV, Zhang James Y, Reif A. Alcohol use disorders and ADHD. Neurosci Biobehav Rev 2021; 128:648-660. [PMID: 34265320 DOI: 10.1016/j.neubiorev.2021.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022]
Abstract
Despite a growing literature on the complex bidirectional relationship of ADHD and substance use, reviews specifically focusing on alcohol are scarce. ADHD and AUD show a significant genetic overlap, including genes involved in gluatamatergic and catecholaminergic neurotransmission. ADHD drives risky behavior and negative experiences throughout the lifespan that subsequently enhance a genetically increased risk for Alcohol Use Disorders (AUD). Impulsive decisions and a maladaptive reward system make individuals with ADHD vulnerable for alcohol use and up to 43 % develop an AUD; in adults with AUD, ADHD occurs in about 20 %, but is vastly under-recognized and under-treated. Thus, routine screening and treatment procedures need to be implemented in AUD treatment. Long-acting stimulants or non-stimulants can be used to treat ADHD in individuals with AUD. However, it is crucial to combine medical treatment for ADHD with pharmacotherapy and psychotherapy for AUD, and other comorbid disorders. Identification of individuals at risk for AUD, especially those with ADHD and conduct disorder or oppositional defiant disorder, is a key factor to prevent negative outcomes.
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Affiliation(s)
- Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Frankfurt am Main, Germany.
| | - Josep Antoni Ramos Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatryand Forensic Medicine, Universitat Autònoma deBarcelona, Bellaterra, Catalonia, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA; Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Yanli Zhang James
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Frankfurt am Main, Germany
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Daigre C, Rodríguez L, Roncero C, Palma-Álvarez RF, Perea-Ortueta M, Sorribes-Puertas M, Martínez-Luna N, Ros-Cucurull E, Ramos-Quiroga JA, Grau-López L. Treatment retention and abstinence of patients with substance use disorders according to addiction severity and psychiatry comorbidity: A six-month follow-up study in an outpatient unit. Addict Behav 2021; 117:106832. [PMID: 33529849 DOI: 10.1016/j.addbeh.2021.106832] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/10/2020] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The impact of psychiatric comorbidity and addiction features throughout the course of addiction has been widely studied. This is a naturalistic study conducted in an outpatient unit, where treatment follow-up studies are scarce compared to studies including inpatients or those under experimental conditions. Therefore, this follow-up study aims to analyze the treatment adherence and abstinence of outpatients with SUD (Substance Use Disorders) according to addiction severity and psychiatric comorbidity. METHODS The current six-month follow-up study examined 404 SUD outpatients. Psychiatric comorbidity, addiction severity, substance consumption and treatment adherence were systematically evaluated using semistructured interviews. Survival analyses were conducted to compare the time of treatment adherence and abstinence in a bivariate and multivariate level. RESULTS A progressive dropout was observed, reaching 32.2% of dropouts at the six-month follow-up. More than 50% achieved abstinence during the first month and similar percentages were found until the six-month follow-up. At the multivariate level, treatment adherence, cannabis use disorder and polyconsumption were independently associated with earlier dropout. ADHD was the only mental disorder significantly related with dropout. Regarding substance consumption, the time of abstinence was independently associated with months of treatment adherence and the achievement of abstinence before starting treatment. In general, dual diagnosis was associated with less time of abstinence, but only depressive disorder across the lifespan was related to less time of abstinence in the multivariate model. CONCLUSION These findings highlight the importance of an accurate diagnosis at the beginning of treatment, especially in an outpatient setting, addressing the treatment needs and promoting strategies that improve treatment adherence and reduce the risk of relapses.
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Affiliation(s)
- Constanza Daigre
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain.
| | - Laia Rodríguez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Roncero
- Psychiatry Service, Salamanca University Health Care Complex, Institute of Biomedicine, University of Salamanca, Salamanca, Spain; Psychiatry Unit. School of Medicine. University of Salamanca, Spain
| | - Raul Felipe Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain
| | - Marta Perea-Ortueta
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marta Sorribes-Puertas
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Nieves Martínez-Luna
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain
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Anker E, Ginsberg Y, Heir T. Prevalence of criminal convictions in Norwegian adult ADHD outpatients and associations with ADHD symptom severity and emotional dysregulation. BMC Psychiatry 2021; 21:226. [PMID: 33941124 PMCID: PMC8091664 DOI: 10.1186/s12888-021-03223-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) often co-occurs with antisocial behaviour. Several studies have shown high rates of ADHD among prisoners. However, the prevalence of crime among individuals with ADHD is less known. The aim of the present study was to estimate the prevalence of lifetime criminal conviction (CC) in a clinical sample of adults with ADHD, and the associations with the severity of ADHD and emotional dysregulation (ED). METHODS Patients were admitted to a private psychiatric outpatient clinic in Oslo between 2014 and 2018. Of the 656 patients diagnosed with ADHD, 629 (95.9%) agreed to participate in the study. CC was determined based on self-reporting of the lifetime history of criminal behaviour. ADHD was diagnosed according to the DSM-5 criteria, and ADHD severity was measured using the Adult ADHD Self-Report Scale (ASRS). ED was assessed by the eight-item version of Barkley's Current Behaviour Scale - Self-Report (CBS-SR). RESULTS The prevalence of self-reported CC in this clinical sample was 11.7% among women and 24.5% among men. CC was associated with hyperactive-impulsive severity (p < 0.001) and ED (p = 0.006). CONCLUSIONS The prevalence of self-reported lifetime criminal conviction was high for both genders. CC was associated with symptom severity of hyperactivity-impulsivity and emotional dysregulation. The findings suggest the need for greater research efforts on the avoidance of criminal activity in people with ADHD and targeted intervention for ADHD treatment and CC prevention.
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Affiliation(s)
- Espen Anker
- Oslo ADHD Clinic, Kirkeveien 64B, 0366, Oslo, Norway.
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Trond Heir
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
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45
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Management of Attention-Deficit/Hyperactivity Disorder in Adults. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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46
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Razzak HA, Ghader N, Qureshi AA, Zafar M, Shaijan JF, Al Kuwari M. Clinical Practice Guidelines for the Evaluation and Diagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A systematic review of the literature. Sultan Qaboos Univ Med J 2021; 21:e12-e21. [PMID: 33777419 PMCID: PMC7968915 DOI: 10.18295/squmj.2021.21.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/20/2020] [Accepted: 08/13/2020] [Indexed: 12/04/2022] Open
Abstract
This article presents a comprehensive review of clinical practice guidelines (CPGs) for the evaluation and/or diagnosis of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. A systematic review was undertaken to summarise the recommendations reported in CPGs. MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA), Cumulative Index to Nursing and Allied Health Literature® (EBSCO Information Services, Ipswich, Massachusetts, USA) and other databases were searched to retrieve CPGs. A total of five guidelines were included for analysis. The selected CPGs were appraised independently by five reviewers using the AGREE II instrument. The highest total score was achieved by the National Institute for Health and Care Excellence guidelines (91.4%) followed by the CPGs from the Scottish Intercollegiate Guidelines Network, Canadian Attention Deficit Hyperactivity Disorder Resource Alliance, British Association of Psychopharmacology and the American Academy of Paediatrics. By appraising current ADHD guidelines, clinicians cannot only identify CPGs related to ADHD but can also determine which guidelines should be considered of high quality and trustworthy to follow during clinical practice. The researchers recommend using the AGREE II instrument for CPG appraisal in healthcare professional education and training. Improvements in the applicability of guidelines are warranted in the future to enhance its clinical use and relevance.
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Affiliation(s)
- Hira Abdul Razzak
- Statistics and Research Center, Ministry of Health & Prevention, Dubai, United Arab Emirates
| | - Nariman Ghader
- Specialized Care Department, Ministry of Health & Prevention, Dubai, United Arab Emirates
| | - Ateeq A Qureshi
- Department of Child & Adolescent Mental Health, Maudsley Health, Dubai, United Arab Emirates
| | - Mehnaz Zafar
- Department of Psychiatry, Al Amal Psychiatry Hospital, Dubai, United Arab Emirates
| | - Jeena F Shaijan
- Department of Psychiatry, NMC Medical Centre, Dubai, United Arab Emirates
| | - Muna Al Kuwari
- Specialized Care Department, Ministry of Health & Prevention, Dubai, United Arab Emirates
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47
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Kast KA, Rao V, Wilens TE. Pharmacotherapy for Attention-Deficit/Hyperactivity Disorder and Retention in Outpatient Substance Use Disorder Treatment: A Retrospective Cohort Study. J Clin Psychiatry 2021; 82. [PMID: 33988929 PMCID: PMC8351325 DOI: 10.4088/jcp.20m13598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the relationship between short- and longer-term retention in outpatient substance use disorder (SUD) treatment and pharmacotherapy for comorbid attention-deficit/hyperactivity disorder (ADHD). METHODS In this retrospective cohort study conducted in a single addiction psychiatry clinic, electronic health record data from July 14, 2014, through January 15, 2020, were queried for clinical ADHD diagnosis (DSM-5 criteria), ADHD pharmacotherapy, treatment duration, demographic variables, comorbid psychiatric and SUD diagnoses, and buprenorphine therapy. Individuals with ADHD (n = 203) were grouped by ADHD pharmacotherapy status (171 receiving medication compared to 32 receiving none). Kaplan-Meier and Cox proportional hazards regression analyses were performed and assessed for significance. RESULTS ADHD was clinically diagnosed in 9.4% of outpatients and was associated with younger age, comorbid cocaine use, and private insurance (P < .001). Individuals receiving no ADHD pharmacotherapy were younger than those receiving medication (P = .003). Compared to no ADHD medication, ADHD pharmacotherapy was associated with greater long-term retention, with apparent group half-lives of 9 months and 36 months, respectively (P < .001). Individuals receiving no ADHD medication had a 4.9-fold increased likelihood of attrition within 90 days (P = .041). Regression analysis showed only ADHD pharmacotherapy to be significantly associated with treatment retention (hazard ratio = 0.59; 95% CI, 0.40-0.86; P = .008). CONCLUSIONS ADHD pharmacotherapy is robustly associated with improved short- and longer-term retention in outpatient SUD treatment. The retrospective, nonrandomized naturalistic study design limits causal inference. Further studies addressing unmeasured covariates and associated risks of treatment in adults with ADHD and SUD are necessary.
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Affiliation(s)
- Kristopher A Kast
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Corresponding author: Kristopher A. Kast, MD, 1601 23rd Ave South, Nashville TN, 37212
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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48
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Gerhardt S, Luderer M, Bumb JM, Sobanski E, Moggi F, Kiefer F, Vollstädt-Klein S. Stop What You're Doing!-An fMRI Study on Comparisons of Neural Subprocesses of Response Inhibition in ADHD and Alcohol Use Disorder. Front Psychiatry 2021; 12:691930. [PMID: 34603097 PMCID: PMC8481878 DOI: 10.3389/fpsyt.2021.691930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/13/2021] [Indexed: 01/20/2023] Open
Abstract
Rationale: Both attention deficit-/hyperactivity disorder (ADHD) and alcohol use disorder (AUD) are accompanied by deficits in response inhibition. Furthermore, the prevalence of comorbidity of ADHD and AUD is high. However, there is a lack of research on whether the same neuronal subprocesses of inhibition (i.e., interference inhibition, action withholding and action cancellation) exhibit deficits in both psychiatric disorders. Methods: We examined these three neural subprocesses of response inhibition in patient groups and healthy controls: non-medicated individuals with ADHD (ADHD; N = 16), recently detoxified and abstinent individuals with alcohol use disorder (AUD; N = 15), and healthy controls (HC; N = 15). A hybrid response inhibition task covering interference inhibition, action withholding, and action cancellation was applied using a 3T functional magnetic resonance imaging (fMRI). Results: Individuals with ADHD showed an overall stronger hypoactivation in attention related brain areas compared to AUD or HC during action withholding. Further, this hypoactivation was more accentuated during action cancellation. Individuals with AUD recruited a broader network, including the striatum, compared to HC during action withholding. During action cancellation, however, they showed hypoactivation in motor regions. Additionally, specific neural activation profiles regarding group and subprocess became apparent. Conclusions: Even though deficits in response inhibition are related to both ADHD and AUD, neural activation and recruited networks during response inhibition differ regarding both neuronal subprocesses and examined groups. While a replication of this study is needed in a larger sample, the results suggest that tasks have to be carefully selected when examining neural activation patterns of response inhibition either in research on various psychiatric disorders or transdiagnostic questions.
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Affiliation(s)
- Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan M Bumb
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Child and Adolescent Psychiatry, University Medical Center Mainz, Mainz, Germany
| | - Franz Moggi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Feuerlein Center on Translational Addiction Medicine, University of Heidelberg, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Miovský M, Lukavská K, Rubášová E, Šťastná L, Šefránek M, Gabrhelík R. Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity. Eur Addict Res 2021; 27:87-96. [PMID: 32781442 DOI: 10.1159/000508571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. OBJECTIVE To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. METHODS A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25-34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. RESULTS ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson's r's = 0.30-0.42, p's < 0.001) and the symptoms of hyperactivity disorder (r's = 0.24-0.30, p's < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). CONCLUSIONS The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.
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Affiliation(s)
- Michal Miovský
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia,
| | - Kateřina Lukavská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Eva Rubášová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lenka Šťastná
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Martin Šefránek
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
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50
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Managing Comorbid Attention Deficit Hyperactivity Disorder (ADHD) in Adults With Substance Use Disorder (SUD): What the Addiction Specialist Needs to Know. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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